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HomeMy WebLinkAbout038-1032-80-000 ST. CROIX COUNTY ZONING DEPARTMENT AS BUILT SANITARY REPORT Owner c .. Address City /State Legal Description: s' c.ROrx Lot 1PA Block 1" Subdivision/CSM # N tt r-) NrNGOFF ICE /, /, NQ. Sec. ,TAN -R_1�'W, Town of r PIN, SEPTIC TANK — DOSE CHAMBER — HOLDING TANK INFORMATION I � Tank manufacturer i 9 sir Size ST/PC /Qp loo° Setback from: House Q Well p/L, Pump manufacturer 5 -Model 3 $K c �, Alarm location 17 (HOLDING TANKS ONLY) Setbacks: Service road Vent to fresh air intake Water Line Meter location Alarm location SOIL ABSORPTION SYSTEM: Type of system: Width Lenfgth Number of Trenches Setback from: House Well p/l,O Vent to fresh air intake fn 7 ELEVATIONS Description of benchmark !1 n � ; ,.� r� Elevation / cz= Description of alternate benchmark Td �, b1 la . ' Elevation i os ol3 Building Sewer ST/HT Inlet ST Outlet PC Inlet •v PC Bottom �� Header/Manifold 3• Top of ST/PC Manhole Cover ' 77 U Distribution Lines () ? j, ( ) Bottom of System Final Grade Date of installation tl/O(Y APer u � mber 0 77 State plan number Plumber's signature License number � � Date'? / /D/ Inspector C4 Complete plot plan * .IVisconsirr Department of Commerce Safety and Buildings Division PRIVATE SEWAGE SYSTEM CountHT, CROIX INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Sanitat3l[Wgi(M.: Personal information you provice may be used for secondary purposes (Privacy LXw, s.15.04 (1)(m)]. Permit Holder's Name: EINTZ, RICK 19-fMlapp wn of: State Plan ID No.: CST BM Elev.: Insp. BM Elev.: BM Description: 1 Parcel W Se-103 2-80 tf TANK INFORMATION EVATION DATA A9 EL TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. e ti V L,� 1 oc9 d Benchma k Z .$� to„t.� )o d . os,n Co+ io bop ALt.'Pbrv4 2.22 10S .off Aeration Bldg. Sewer i3a� Holding Inlet jo�,� Iz•12' 4 70.` - 7 c,/ TANK SETBACK INFORMATION St/ Ndt Outlet TANKTO P/L WELL BLDG. Airi to ntake ROAD Dt Inlet Air I Septic I La �S ,,.1„ NA Dt Bottom gr7 • /� Dosing !.i 1 ` qs� NA Header / Man. �p�s G� ,g Aeration ( NA Dist. Pipe (o /• • (p qy.cjY Holding Bot. System �O(. 3 W PUMP/ SIPHON INFORMATION - 7� >72�k Final Grade Manufacturer G d J Demand p��lea- beer Model Number W 3l �O GPM b� Cw TDH Lift"] Lriction (3 FSrstem2 TDH ,(fit r ��""I 5� /0 /, /0(3 ea Forcemain Length ' a. H 11 Dist. To ell SOIL ABSORPTION SYSTEM E RENCH Width Length�� No. Of Trenches PIT No. Of Pi Inside D a. Liquid Depth EN I N '—_ DIMENSION SETBACK SYSTEM TO P / L BLDG WELL LAKE/STREAM LEACHI G Manufac rer: C INFORMATION Type O HAMBE Mo Num r: System:1IVlpdyf 1 2W0 3�5 OR UNIT DISTRIBUTION SYSTEM Header / M old �l Distribution Pipes) x Hole Size x Hole Spacing Vent To Air Intake Length Dia. Length _257 Dia.' t, 2 Spacing t I it a y SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over a Depth Over R xx Depth Of rr xx Seeded/ Sodded xx Mulched Bed/ Trench Center �V Bed /Trench Edges Topsoil ( Yes ❑ No lR Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc. STAR PRARIE 8.31.18. 148 , SW, NW 2 .2C 90TH STREET LOCATION TO p b�d� ��e£aa,� �. a� �'z - 57 F�l / -7a Plan revision required? ❑ Yes ® No �� Use other side for additional information. SBD -6710 (R.3/97) Date Inspector's Sig g— C rt. N A scons i n SANITARY PERMIT APPLICATION Department of Commerce In accord with ILHR 83.05, Wis. Adm. Code • Attach complete plans (to the county copy only) for the system, on paper not less Count than 8 1/2 x 11 inches in size. • See reverse side for instructions for completing this application State San ry F s 6 The information you provide may be used by other government agency programs ❑ Check it revision to p, [Privacy Law, s. 15.04 (1) (m)). State Plan I.D. Number I. APPLICATION INFORMATION - PLEASE PRINT ALL INF RMATI N I Prope Owner Name Property Location t Sw1 /4 N S T , N, R j� , W Property wne s Mailing ddressl Lot Number BIo4k tuber A30 n. tD cit , State Zi Code Phone Number Subdivision Name or CSM Number t+ 1 7 ( - Ju) e 90 V IF BUILDING: (check one) ❑ State Owned 11 lt� t �, Nearest Ro ❑ VII age Public 1 or 2 Family Dwelling - No. of bedroom Town OFS11x.r III. BUILDING USE (if building type is public, check all that apply) Parcel Tax Number(s) -'� /• �� �j 1 ❑ Apartment/ Condo 03 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. New 2_ E:] Replacement 3. E3 Replacementof 4_ ❑ Reconnection of 5_ E] Repair of an ____ -------- 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 21Mound 30 E] Specify Type 41 [ Tank 12 E] Seepage Trench 22[] Pressure 42 ❑ Pit Privy 13 ❑ Seepage Pit 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 (s ft.) Pro osed (sq. ft.) (Gals/day /sq. ft.) (Min. /inch) q os -- Elevation Feet 4 M_ Feet VII. TANK Capacity gallo s Total # of Prefab. Site Fiber- Exper. INFORMATION Gallons Tanks Manufacturers Name concrete Con- steel glass Plastic App New Existin structed Tanks Tanksl Tanks Septic Tank atk"ft 000 ❑ ❑ ❑ ❑ ❑ Lift Pump Tank pt) / ❑ ❑ ❑ ❑ ❑ ❑ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for inst lation of the onsite sewage system shown on the attached plans. Plumber's Name: int) M;1� mp s) MP /MPRSWNo.: Business Phone Number: ` © If 53 7 Q S4 (o l�S Plumber's Address (Street, Ci S Zip Co e): I _ t 5 O IX. COUNTY / DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (includes Groundwater D ate I ssued Issuln Agent Signature (No Stamps) KA roved w Surcharge Fee) � pp ❑Owner Given Initial V pd Adverse Determination co X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SBD-63M (R I IM) DISTRIBUTION: Original to County. One copy To: Safety & Buildings Division, Owner, Plumber Safety and Buildings 2226 ROSE ST LA CROSSE WI 54603 -1905 I sconsin Tommy G. Thompson, Governor Department Of Commerce William J. McCoshen, Secretary April 07, 1998 CUST ID No.220537 ATTIC• POWTS INSPECTOR CALVIN W POWERS JR 1969 185TH AVE NEW RICHMOND WI 54017 RE: CONDITIONAL APPROVAL Transaction ID No. 71448 APPROVAL EXPIRES: 04/07/2000 SITE: Site ID: 4775 ST CROIX County, Town of STAR PRAIRIE SWl /4, NWl /4, S8, T3 IN, RI 8W RICK HEINTZ FOR: Description: MOUND Object Type: POWT System Regulated Object ID No.: 11355 The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes listed in the regarding line above. The submittal has been CONDITIONALLY APPROVED. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. The following conditions shall be met during construction or installation and prior to occupancy or use: • 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 /installation/operation. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. When making an inquiry or submitting additional information, please refer to Transaction ID No. in the regarding line. Sincerely, /J t DATE RECEIVED 03/27/1998 FEE REQUIRED $ 180.00 GERARD 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 JS WIM @COMMERCE. STATE. WI.US P Department of Commerce PRIVATE SEWAGE SYSTEM lr' Safety and Buildings Division REVIEW APPLICATION Bureau of Integrated Services Hayward Office LaCrosse Office Madison Office Shawano Office Waukesha Office - 209 W. 1st St. 2226 Rose Street 201 E. Washington Ave. 1340 E. Green Bay St. 401 Pilot Court, Ste. C Rt 8, Box 8072 La Crosse, 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) 6344804 Fax (608) 785 -9330 Phone (608) 266 -3151 Phone (715) 524 -3626 Fax (414) 548 -8614 Fax (715) 634 -5150 Fax (608) 267 -9566 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 two working days 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 submit. PLEASE PRINT VERY CLEARLY. A sample of a completed form is on the reverse side for your reference. Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1)(m)). 1. APPOINTMENT INFORMATION - If you have scheduled an appointment, fill in the information requested below to save time: Appointment Date Revie er Name Plan Identification Number 7' O - C W Swt 7/ I !O 2. PROJECT INFORMATION If this mvie=revJAon or extension to your existing number, provide that number here: Proje ame County 199" ❑City ❑Village [M Town of: Project Location S M S —t " G GOVT. LOT S W 1/4 1/4 �i� or) W 3. APPLICATION FOR 4. FEE COMPUTATIONS FEE SUBMITTED System Type (check one): System Type I (include new and existing tanks) A ❑ At -Grade Up To 1,500 gallon septic tank . ............................... ....$110.00.................... �� d H ❑ Holding Tank 1,501 - 2,500 gallon septic tank .... ............................... ..$120.00...................... M Q Mound 2,501 - 5,000 gallon septic tank .... ............................... ..$160.00...................... N ❑ Non - Pressurized in- Ground (Conventional) 5,001 - 9,000 gallon septic tank .... ............................... ..$200.00...................... P ❑ Pressurized In- Ground 9,001 - 15,000 gallon septic tank .... ............................... ..$300.00...................... O ❑ Other: Over 15,000 gallon septic tank .. ............................... ....$500.00.................... Up To 1,000 gallon dose chamber . ..............................$ 70.00.................... 70 Building Type (check one): 1,001 - 2,000 gallon dose chamber . ..............................$ 80.00...................... D E' Dwelling, 1 or Family 2,001 - 4,000 gallon dose chamber ............................. ..$100.00...................... P ❑ Public Building 4,001 - 8,000 gallon dose chamber ............................. ..$120.00...................... S ❑ State -Owned Building 8,001 - 12,000 gallon dose chamber ............................. ..$140.00...................... Over 12,000 gallon dose chamber ............................. ..$160.00...................... Up To 5,000 gallon holding tank .... ..............................$ 60.00...................... Code Derived Daily Flow � gpd 5,001 : 10,000 gallon holding tank .. ............................... ..$100.00...................... Over 10,000 gallon holding tank . ............................... ..$150.00...................... ❑ Check if Replacing Existing System Experimental System (additional one time fee) .............. ..$300.00...................... Revisions to Approved Plan 2 ........... ..............................$ 60.00...................... Petitions for Variance: Setback .. ............................... ..$100.00...................... ❑ Petition for Variance Site Evaluation ....................... ..$225.00...................... Plumbing ... ............................... $225.00...................... Revision. .$ 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: ................... f�t Priority Review: Enter same amount as Subtotal: ................... MAKE ALL CHECKS PAYABLE TO: SAFETY AND BUILDINGS DIVISION Total Fee: ................... /80 5. SUBMITTING PARTY INFORMATION Telephone No. (include area code & extension) pany Name Contact Person (7/ ) '�s' �- O c•.� a� 1 ' c . C al v i v., O WAS No. & Street Address or P.O. Bo Ci , Town or ge, State Zip Code 1 7 / C , hW W rlIJ (A) X, Aerobic or prepackaged treatment system fees are calculated based on equivalent size septic tanks and lose 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 OVER — ---� SBD -8748 (R. 07/98) WORKSHEET - MOUND SYSTEM DESIGN n a•nc \' PROBLEM: 7144 Design a mound system for a The site characteristics are: 'ljitt C.01 Depth to groundwater or bedrock n c ® O � . o oy r Landsl o e ►�pR�M FEjy P of o sp Percolation rate ° ES �V_ .,!,, min. /in. Distance from dose chamber to d i i system ft. Elevation difference between aump and distribution system 5 ft. Step 1. WASTEWATER LOAD 3 ._, gal.'. Step 2. SIZE THE ABSORPTION AREA , A) Area required •° I Z _ 375 sq. ft. T ` B) Bed or trench length (B) • C) Bed ' or trench width (A) ertCh spaci R (C3` , k Wase+a rrr 1 .24 gal /f t 2 .24 B . /VI ft. tre c T. Step 3. MOUND HEIGHT A) Fill depth (D) B) Fill depth (E) ■ D + slope (A)+P) 1 )S ft C) Bed or trench depth (F) 6 D)' Cap and topsoi 1- depth (c,1 s „ ft. N. E) Cap d topsoil depth(H) /.ft. t ape Licence i\Tu �O , ?Date . Step 4. MOUND LENGTH A) End slope (K) _ C D + E + F + H x 3 ■ /� ��a ft. �� �i J3) +.83ti, X-3 = /0 13 B) Total mound leng (L) = B + 2(K) a _9 ft. Step 5. MOUND WIDTH Al) Upslope correction factor 3� A2) Upslope width (J) ►+ (D + F + G)(3)(factor) _ g ft.. C -4,93-t /) x 3 X. 9 r s 7, 74 B1) Downslopi! correction factor = - 37 - - B2) Downslope width (I) _ -(E + F + G)(3)(factor) 9.9 ft. (111-57t 93 -rl 3 x A 10 - %g 3q Cl) Total mound width (W) for bed J + A + I 7 ft. C2) Total mound width (W) for trenches ■ �, J + � + (no. trenches -1)(c) + A + I ft. I Step 6. BASAL AREA A) Infiltrative capacity of natural soil S „ gal. /ft /day B) Basal area required ■ wastewater flow natural soil infiltrative capacity - 9 0n sq. ft. C� C1) Basal area available for bed for sloping sites ■ i C2) Bas are avail le for trench for sloping sites 0�2 B W �J + A 1 /�1D sq. ft. a� C ], g+ 21 c/3®,,® J 41 Basal area available for ch or bed for level si es = B x W = 1�1f �_ sq. ft. "7— LicensDate 0 p i,u•rt 0.� e. Step 7. DISTRIBUTION SYSTEM 1330 � &o R ►��.�,�,r,a S �,� 7A) SIZE DISTRIBUTION SYSTEM 1) Hole size in. 2) Hole spacing in. 3) Distribution pipe length a 4) Distribution pipe diameter /� in. 5) Spacing between distribution pipes ■ O in. 6) Distance from sidewall to distribution pipe -30 in. 1B) DISTRIBUTION PIPE DISCHARGE RATE .�_.�E_ ft. 1) Number of holes per pipe p _� 2) Flow per pipe = ' z� GPM 7C) SIZE MANIFOLD 1) Manifold is �_ central/ end 2) Manifold length D 3 D ft. 3) Number of distribution lines = 4) Manifold diameter in. 7D) SIZE FORCE MAIN 1) Minimum dosing rate = f��,Li, GPM 2) Force main diameter 7 2 .3 in. 3) Friction loss - // ft. 7E) TOTAL, DYNAMIC HEAD 1) Vertical lift a _ 7, ft. 2) Friction loss = 7-? ft. 3) System head 2.5 ft. a.S ft, r� Total dynamic head ft. Ucorae: as o J 3 3 --a - � � 7F) PUMP SELECTION 1) Pump selected will discharge 6�D _ GPM at /S ft. total dynamic head. 2) Pump model and manufacturer .380 3//4 7G) DOSE VOLUME 1) 10 times void volume of distribution lines gal. /cycle 2) Daily wastewater volume 4 4 doses /24 hrs, _ i /a..S gal. /cycle ySo ' s' /� 3) Minimum dose volume a gal ./cycle 3L8_ �S.? 7H) DOSE CHAMBER /G 7• 1) Minimum capacity required = '5 7 gal. 600 r.&j i Sign Joe License 'u: llaD,$ Date 3 —1,S — 9 IR 0 1A �.L I sw Nw 0 5 7 /000c�..�.P� Vie•, .k, �� Rum• -� S��t��� '�ern►b�+�wtra� m owr,d a .7 A 1 5, - " 75 61 t.,ws t o -55 3 a� y C t1 ti Qtt 4-f� MF ZMEN� OF �U11 S{��E� F SEA CORR O a ° C a `_`' o • ,3 N rya 3 S_ Ccn+.loi ncc'�'co� Page of 1330 �Q +w Straw, Marsh Hay, Or , Synthetic Covering 3 3 Distribution Pipe -- Mr t'am Sand -� -fb- _ -µ-ms- I t`- . r Topso it _- --� — -- - - -- — ° �2� Slope Bed Of - %z Force Main Plowed Aggregate. Layer D / Ft. Cross Section Of A Mound System Using E /, /S Ft. F J Ft. A . Bed For The Absorption Area G / Ft. A S Ft. H /.S Ft. gned: B Ft. tense Number: 0 K Id, :2 Ft. te: -as - 9fs' E 95,5 Ft. d 7.!R Ft. Alternate Position I 9, Ft. of Force Main W �?a'7 Ft L d Observation Pipe I �, Forc e Moin Distribution �ed Of 2�- 2 z� Pipe Aggregate I Observation Pipe Permanent Markers Plan View Of Mound Using A Bed For The Absorption Area RiG�,rn Page ..L_ Sya >> Psrforolod Pipe Detail n End View ) p4r(orolsd End Cap \e,y' PVC Pipe Holes Located On Bottom, c ' Are Equally Spaced x Lail Hole Should Be Next To End Cap Dittribulion Pipe Layo P - 37 Ft. R S X a` Inches Y Inches Signed: r Hole Diameter —I /y Inch License Humber a�o5 37 Lateral JY.?- IncM s) Manifold .,3 Inche:; Date: Force Main I nC1103 R of holes /pipe 19 Invert Elevation of Laterals Ft. S EPTIC TANK & PUMP CAMBE CROSS SECTION AND SPECIFICATIONS ia►� g 1 ►ok e� . • o .` R L� �� 4" CI VENT PIPE 12" MIN. ABOVE GRADE E WEATHER PKOOF >_ 25' FROM WINDOW OR JUNCTION BOX APPROVED FRESH AIR INTAKE WITH CONDUIT MANHOLE COVER FINISHED GRADE 4" CI RISER W/ PADLOCK 6 6" MIN. WARNING LABEL ABOVE GRADE 4 — 4" MIN. 18" I. 6 MAX. INLET WATER TIGHT SEALS !' GAS- TIGHT i r 4 �� BAFFLE A SEAL i PROVED CI PIPE —�-- ALINTS W/ CI 3' ONTO B i ON PE 3' ONTO SOLID , LID SOIL SOIL PUMP OFF ELEV . FT. -- eRISER EXIT D RMITTED ONLY TANK ANUFACTURER HAS APPROVAL 3" APPROVED BEDDING UNDER TANK CONCRETE PAD SPECIFICATIONS t SEPTIC / DOSE TANK MANUFACTURER: A)W tof CSee NUMBER DOSES PER DAY: TANK SIZES SEPTIC IaV GAL. DOSE VOLUME INCLUDING DOSE GAL. FLOWBACK: GAL. ALARM MANUFACTURER: $ t-T E/ - CAPACITIES: A = INCHES = _3 CD GAL. MODEL NUMBER: 161 /,4,,,j —' SWITCH TYPE: �r/ -r B = 2 INCHES = -33,y GAL. PUMP MANUFACTURER: G o4 fj5 C = - h, INCHES = ��� GAL. MODEL NUMBER: �ffft.S' LJ F-:,o3 //L SWITCH TYPE: �C-�- D = S,f_ INCHES REQUIRED DISCHARGE RATE 7D GPM PUMP 8 ALARM WIRING AS PER ILHR 16.23 WAC VERTICAL DIFFERENCE BETWEEN PUMP OFF AND DISTRIBUTION PIPE 7 FEET + MINIMUM NETWORK SUPPLY PRESS . . . . . . . . . . . 2.5 FEET + / D FEET FORCEMAIN X •`i? FT /100 FT. FRICTION FACTOR .7 FEET T.OTAL DYNAMIC HEAD = FEET INTERNAL DIMENSIONS OF PUMP TANK: LENGTH — ; WIDTH ; DIAMETER LIQUID DEPTH / A. J j SIGNED: _ LICENSE NUMBER aQo337 DATE: 3 -a5 1/88 y + � u ZUBMERMLE 'Q SE 3 il.: I,A 1�t 11. 1 1 LJ E F F L V E NT P UNIPS {•\. ' ?'' [ 4�1 Id *") EP03r11 W \ \ LIST__ DISC. • GOUPEP0311 142 FF0311 1/3 tip 115 V EEflucnt Pimp 1/2" solids I 256.8 1 72.10 - �, }., Submersible MODEL EP0311 1 n at ; .,t Effluent:. Pump. . METERS FEET SIZE 3 /a t SOLIDS 25 ''r'+7 t 10 ' r 0 0 0 4 e 12 15 20 24 28 32 34 40 ' GPM 0 25 5.0 7.5 m'!A. CAPACITY • Perion ' Curve IIRtn4 1ttt • ' i l ' 90 "mss n — SIZE 4' Solids yk; a yr' 70 { ti 70 ,�• >' wrong_.. _ b Wt05N ' 20 wtox - _ _ t _ — �. .,' - 1.... 0 10 20 00 *0 60 6o ' 10 6o 90 100 110 • 110 Ofti1 CAMCITV :... :' •: LIST DISC. • ft � +lf;s ,. GMT%,'E0311I. 1 <2 HE0311L 1/3 lip 115 V Low H 3/4' tolids 1{91 .5S 329.35 r. QJt.'R,'8031114 142 WE031 W 1/3 111? 115 V H 3/4" solids 491 .55 329.35 + 1 ,z GJUPhZ0;1111 142 no5111f 1/2 1M 115 V High H 3 /4'.,6lids 704.25 411.85 43.65 565.25 it i )� ((i , 4 ,. OJMIC0112t1 142 1 HT0712H 3/4 t1P 230. V H1gh W. 3/4" solids R y1d A t �$ 1i "•• "SEE FOI,uNIt1; PAGE FM PEJUavna Im SPECIFICATTOns. ' `�' nk 10/88 DG'T 30 PAGE 07u Wig iDepartmentofIndustry, SOIL AND SITE EVALUATION REPORT Pa e o Labor and Human Relations 9 � f Division of Safety & Buildings in accord with ILHR 83.05, Wis. Adm Code i 7 E COUNTY ,. ,5* Cr�Ix Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. ar .fr}jst include, trot not limited to vertical and horizontal reference point (BM), direction and ° /dof slope, Kale?ARCEL I.D. # dimensioned, north arrow, and location and distance to nearest road. L j 2 - /03 APPLICANT INFORMATION- PLEASE PRINT ALL INFORMATIOI4' REVIEWED BY DATE •P PR ERTY OWNER. PROPERTY 1.6WION I IG k 9 1 'GOVT. MFo�&,k) 1 /4/)W 1 /4,Sy T3/ N,R /.O or) W PROPERTY OWN R': ILI DRESS ', ' LOT NAME OR CSM # `,N A- Ni°r ry A CITY, ST PE ZIP CODE PHONE NUMBER ❑CITY ❑VILj E XYOWN NEAREST ad S O f 7 (7/S)0 6 - S� 7 - io 6 K New Construction Use Residential / Number of bedrooms [ ] Addition to existing building ( ] Replacement [ ] Public or commercial describe Code derived daily flow 450 gpd Recommended design loading rate 1 J� bed, gpd /ft r t trench, gpd /ft Absorption area required bed, ft trench, ft Maximum design loading rate , bed, gpd /ft ' L trench, gpd/ft Recommended infiltration surface elevation(s) R 3 , o s It (as referred to site plan benchmark) Additional design / site considerations N/A Parent material Pfd G]Ir S+ Flood plain elevation, if applicable A)JA ft S = Suitable for system CONVENTI NAL I MOUND IN- GROUND PRESSURE I AT -GRADE SYSTEM IN FILL I HOLDING TANK U= Unsuitable fors stem I ❑ S AU I XS ❑ U EIS U EIS ®U I CIS N U SOIL DESCRIPTION REPORT t f 4j C� �a�a Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft in Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench Ground 3 75 S" S s f a m sbk 15 elev. ft. Depth to limiting factor R • Remarks: Boring # C 2 y a •aS 7 5 — is f s1.k m z • 5 4 Ground elev. Depth to limiting factor Remarks: CST Name:— Please Print r1 Phone: 7/ S- _ y , ` 5) 3S lr �) v� O c•� cL r Address: / ? t?I G �-, Signature: / Date: CST Number: S . R ►ck 14 ci4 ip SW -NW SA.cA 131-19L 5Tar Tr yF!P— o rte SO 3 L _ 7s° -7s-' - a i WigcorsinDepartmentofIndustry, SOIL AND SITE EVALUATION REPORT Page o. Labor and Human Relations g Divisiop of safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code COUNTY V r Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but r 1 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. d 3 — /03 APPLICANT INFORMATION PLEASE PRINT ALL INFORMATION REVIEWED BY DATE PROPERTY OWN : PROPERTY LOCATION R I G e I r GOVT. LOT 5tJ 1/4 /U (, j 1/4,S S T3/ ,N,R or) W PROPERTY OWN R': AILI DRESS LOT # BLOCK # SUBD. NAME OR CSM # N A- Aj K ry A CITY, ST E ZIP CODE PHONE NUMBER ❑CITY ❑VIL E OWN NEAREST ROAD K New Construction Use N/1 Residential / Number of bedrooms (] Addition to existing building j ] Replacement [ ] Public or commercial describe Code derived daily flow 1 _50 gpd Recommended design loading rate 15 bed, gpd /ft fo trench, gpd /ft Absorption area required bed, ft trench, ft Maximum design loading rate , 5 bed, gpd /ft trench, gpd/111 Recommended infiltration surface elevation(s) (n( OS ft (as referred to site plan benchmark) Additional design / site considerations tiZA Parent material v t Flood plain elevation, if applicable N ft S = Suitable for system CONVENTI NAL I MOUND IN- GROUND PRESSURE I AT -GRADE SYSTEM IN FILL HOLDING TANK U = Unsuitable fors stem 1 ❑ S U gs ❑ U EIS U ❑ S ®U ❑ S ❑ S fSl U SOIL DESCRIPTION REPORT r C.)— Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench a4 >'5 I x , :, a 6.30 Ground -� 75 (� S" S s ( a t71 sbl< f — S , b elev. ft. Depth to limiting fact t • Remarks: Boring # :�i / 7 7, S 3 7 L' a �s o?,�� 7..� .� — is -� ��k m•�� z 5 ,� Ground S 5 S' S� 5 m 5r ` M — , S , IF D elev Depth to limiting factor Remarks: CST Name:— Please Print Phone: C-0, 1� n a�Q�s 7/.s -aye- sip Address: ¢ _ G k Signature: ! Date: y ���/ CST Number: i PROPERTY aiNNER Rtck A rt t n SOIL DESCRIPTION REPORT Page oZ of PARUL I.D. # Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft Boring # Horizon in. - Munsell Cu. Sz. Cont. Color Gr. Sz. Sh. Bed Trernd� ::;. Ground d&A 7-�' S 5Z Q m sr M ii - ' S elev. ft. Depth to limiting factor Remarks: Boring # , M Ground elev. ft. Depth to limiting factor Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: Boring # y 4 :: :. ^•.:.::. t •: L='` Ground elev. ft. Depth to limiting factor I Remarks: ®' r ■■■ ■ ■ ■Ni WFAI ■■ No ■ a ■ ON . -'�■■ ON mm ■ _ : �: , ■■ ■■■■ ■■■■■■■ MMAN■■ ■ ■■■■ ■■■■■■■■■■■ ■- w .■ ■ ■■■■ ■■■ ■EEO■■■■ ■■N ■N ■ ■ ■■■■■■ ■■O■■NN■N■■ ■ ■■ ■■■■■ ■ ■■ ■ ■■ ■■■■■■■■■■■ INNE ■■■■■ ■■ ■■ ■■ ■ ■ ■■ ■NEON IN■■■u 1. ►:1 ■i ►�i'� .TEN ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■■ ■■■ Itir�EEi1ri11mE ■■■■E■■■■E ■■■E■■■■ ■■ ■■■■N■■M■■■■E■E■■■E■■■■■E■EE■E■ ■■■ ■■■■■■M■■N■■■E■■■■■■■■■rw■■E■N■ ■■■■■■E■■�r�■■■■■■■■ �■■■■■INE■■■ES ■ ■■N ■■O■■�W■■■NENE■� ■■■■f ■■■■■■m ■■■■■■■■■M■■■■E■N�■ ■� ■NENa�N■■■■■FA■ ■■NEE■E■■I■■■■ENU M ■E■ ■ ■ ■ ■E■ ■NI ■■■■■■■N ■�� ■NNE Ir■.. ■■ ■ENE ■ ■ ■ ■■■ CIE■ ■■■■■ ■O Q MEMO ■■ ■mmom om, ■ "■■■■■■■■■■■■■■■M,r� MONO N 9 . � S fmmmmmm � Wi■■■■■■■■ ■E■■■■■ - ., ■■■■■ NE ■E■��■■■ �EEE■EEE■NNENNE■, ■NNEN� ■NNE■ ■ ■■ ■� ■O ■■■■ENE ■sEEE■E■N■■■■EEEENN■NNE■ ■NNE■ ■■■ENE■■ ■■E■EEE ■E■EEEEE■■Ei ■E■ ■E ■E■E■E■O ■ ■ EEO■■ ■■■■■■■■■NNi ■■■■■■■E■E■E■E■N NENNEE■■■EE■■■■E� ■iE ■ ■ OOO ■ ■■ ■EEO■ EOEE ■ ■ ■ ■ ■ ■ ■ ■ ■ ■1 ■ ■ ■ ■ ■ ■ ■ ■NE ■NOE ■ ■ ■ ■ ■ ■E ■ EON ■ ■ ■ ■ ■ ■ ■■1 ■■■■E■ ■■N ■■ENNENN■■■■■■■o■■■■■i ■E ■NON ■E ■ ■E ■O ■NO NE■■E■ENEE■ ■� ■ENE ■N ■ ■■E ■OE■■ ■ ■EEO■E■ENNEE■ ■Nov i PW t ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer 1 t Mailing Address 43-3 D J i,-J n y e R t c ►n ��f (,�3 TS�a r Property Address / / l G tVym,p -►-X Car ,5-16 1 7 ,� I (Verification required from Planning Department for new construction) City /State /Uao k 4 W-'� Parcel Identification Number 63 8 A 3 R A LEGAL DESCRIPTION Property Location S(O %a, Al Q 1 /a, Sec. , T 3 N -R /T W, Town of Subdivision 40 ,Lot # Certified Survey Map # . Volume , Page # '— Warranty Deed # 5 717 a Volume 3 6 , Page # Spec house ❑ yes no Lot lines identifiable [W 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, journeymanpl�imber, 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. Itwe, 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. / 74� SIGNATURE OF APP L 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. t 7 // / 9 SIGNATURE OF APP CA 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