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042-1098-50-200
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit NO: 578989 0 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: City Village X Township Parcel Tax No: Holme, Ter W. Warren, Town of 042-1098-50-200 CST BM Elev: Insp. B Elev: BM Description: Section/Town/Range/Map No: U C 35.29.18.544b TANK INFORMATION ELEVATION DATA , / 161, J ab TYPE MANUFACTURER CAPACITY STATION l FS ELEV. ? / ` Septic T.. z Benchmark »(0, Dosing C6.4, to 6 1 Z Alt. BM F.-a At"" Bldg. Sewer e~ ~ 7• z(p 9 3 -6 S. Holding '9t/Ht inlet yam' S~ 7•G( TANK SETBACK INFORMATION St/Ht Outlet ~ TANK TO WELL BLDG. ent t Air Intake ROAD Dt Inlet JDJ Septic Dt Bottom l5 73ar 8' H. ~ 9a . o Dosing Header/Man. 7 1zb t S Z y - S,6`l 97 a Aeration Dist. Pipe 1. U7 q7 or7 Holding Bot. System 33 94 . PUMP/SIPHON INFORMATION Final Grade 7(o7 ?V- 645 Manufacturer z Demand St Cover 1 4 ~ Q tCe. - GPM 9.11-1, 6,1 4"y ~ • -4 , r~ Model Number 23 TDH Lift Friction Loss System Head TDH Ft 7.03 ya 3, z-6- 1 Z. (OF orcemain 1 Length i Dia. L , f Dist. to Well 7 3oa ° SOIL ABSORPTION SYSTEM BEDITRENCH Width / Length / Nes PIT DIME SIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS (0 1 eff SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR Type Of stem: / G J /17 /,13 UNIT Model Number: DISTRIBUTION SYSTEM Header/Manifold / DisUibution / x Hole Sizo x Hole Spacing ! Ven o Air Intake Pipe(s) /I Lengths Dia Z Length Dia Spacing 3 3 1 (0 SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only w Depth Over Depth Over xx Depth of xx Seeded/ dded xx Mulched Bedfrrench Center Bed/Trench Edges Topsoil 1 Yes 0 No ~wv 77 I ~ p ~ es :E] No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection Inspe'ction/~#2: / / Location: 1337 70th Avenue Roberts, WI 54023 (NE 1/4 NW 1/4 35 T29N R18W) NA Lot e4lw`r I,~IVP cAol35.29.18.54 b 1.) Alt BM Description ~ to ~S / / S a J d f Q ~e 6 2.) Bldg sewer length = 3 - amount of cover = SIB e u p Plan revision Required? ® Yes >0o 3 Use other side for additional information. SBD-6710 (R.3/97) Date Insepctor ignature Cert. No. 2h~~^ Safety and Buildings Division County J ~ s ~ $ P ` 201 W. Washington Ave., P.O. Box 1162 Sanitary Permit Number (to be filled in by Co.) ~y S• E Madison, 3707-7162 State Transaction Number ST ~NCROix cs ary Permit Application / 7 In acc''or3diitk'dtit>1IPt3%p}t~. Code, submission of this form to the appropriate governmental unit is required prior to obtaining a sanitary permit. Note: Application forms for state-owned POWTS are submitted to Project Address (if different than mailing address) the Department of Safety and Professional Servies. Personal information you provide may be used for secondary purposes in accordance with the Privacy Law, s. 15.04 1)(m), Stats. W- /33G ~ f I. Application Informati- PI ase Ffint All Information -..JJ Property Owner's Namee Parcel # TEKX Pot- M~ c)'Yz /v 98 5-0„200 Property Owner's Mailing Address Property Location / 3 3-7 7 6 R V Govt. Lot `r City, State Zip Code Phone Number T ty, Section © a s`l p g[6 SN Q (circle on SY ~ T W~ 3 b 3 . R R S 2 l8 Eo r~ T N, IL Type of Building (check all that apply) Lot ® 1 or 2 Family Dwelling -Number of Bedroom °2 ri Subdivision Name 61c. CA Laa Block # ❑ Public/Commercial -Describe Use YYYLLL~~C... ❑ City of ❑ State Owned - Describe Use / CSM Number ❑ Village of n 1 1 , q 3 , ® Town of WNO-'11" 6X va i 1 1 III. Type of Permit: (Check only one bog on line A. Complete line B if applicable) to Existing A. New System El Replacement System El Treatment/Holding Tank Replacement Only El Other Modification System (explain) B• ❑ Permit Renewal ❑ Permit Revision ❑ Change of Plumber ❑ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Owner IV. Type of POWTS System/Component/Device: Check all that apply) ❑ Non-Pressurized In-Ground ❑ Pressurized In-Ground ❑ At-Grade ® Mound ? 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil j1 ❑ Holding Tank ❑ Other Dispersal Component (explain) Pretreatment Device (explain) ` V. Dis ersal/Trea ent Area Information: Design Flow (gpd) Design Soil Applic X Rate(gpdsf) Dispersal Area Requir sf) Dispersal Area Proposed sf) System Elevation no b .5,0o 06(> /a5o y VI. Tank Info Capacity in Total # of WLUN Manufacturer Gallons Gallons Units V y Q~-.~ o U L h New Tanks Existing Tanks V L o a L a U rn ~ v1 w C C. i Septic or Holding Tank ©®G 000 (¢-0~~ Dosing Chamber VII. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) Plumber's Signature MP/MPRS Number Business Phone Number 0J0,-LT-,6J4 004Vzc-LE t 2X-7 -7 /o -rrs, 7 Yq-3?2-2 Plumber's Address (Street, City, State, Zip Code) VIII. oun epartment Use Only Approved ❑ Di roved Permit Fee Date Issued Issuing Signature r Given Rea a fiu.Denial $ ~795' 66 G 15 IX. Cord' nk.'e a sAp fordI)isapproval 3) s tJ~ G 0isl'iersal cell must all be servlees / maintained nn I'o as per management plan provided by plumber axes ~ n ~G- d--`,~ b1- 2. AA > k requirements milst ascc~ / ordinance. Attach to complete plans for the system and submit to the County only on paper not less than 8 In z 11 inches in size SBD-6398 (R.. 11/11) M ~a C M ' o QL 0 3 - ° ~cc a 3 a TIN \IJ v It r o u~ ~ 3 ~ n ILY v ~ e ~ 3 w M v r4Cb i , ~s - a C4 I~ a0 i+ - .v _ Q d A rk '7 .10 ~ 153 i P*Yr an K,4 ULBRICHT & ASSOCIATES CO. 28121 Oth Ave. • Spring Valley, WI 54767 1 Reg- Designers of Engineenng Systems 715-772-8 YM. Private Sewage Consultants MAY 13 2015 RVICES PROJECT INDEX Plan I.D. # Date. 141hy COI S owner TERRY Holm e Phone (05[_.210.-35q? Address 33 7 7(o ft4 Pin T2cn-re t. r ('"0% yNRTnlFf~r DIVISION OF INDUSTRY SERVICES 3824 N CREEKSIDE LA HOLMEN WI 54636 ®s a Contact Through Relay http://dsps.wi.gov/programs/industry-services 9y S www.wisconsin.gov ~0~s81014 NtS~ Scott Walker, Governor Dave Ross, Secretary June 05, 20.15 CUST ID No. 226375 ATTN: POWTS Inspector ROBERT W ULBRICHT ZONING OFFICE ULBRICHT & ASSOCIATES CO ST CROIX COUNTY SPIA 2812 10TH AVE 1101 CARMICHAEL RD SPRING VALLEY WI 54767 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 06/05/2017 SITE: Identification Numbers Terry Holme Transaction ID No. 2546157 1337 70TH Ave Site ID No. 812855 Town of Warren Please refer to both identification numbers, St Croix County above, in all correspondence with the agency. NE 1/4, NW 1/4, S35, T29N, RI 8W FOR: Description: Two Bedroom Mound System / 6% slope Object Type: POWTS Component Manual Regulated Object ID No.: 1536759 Maintenance required; 300 GPD Flow rate; 25 in Soil minimum depth to limiting factor from original grade; System(s): Mound Component Manual - Ver. 2.0, SBD -10691-P (N.01/01, R. 10/12), Pressure Distribution Component Manual - Ver. 2.0, SBD-10706-P (N.01101, R. 10/12); Effluent Filter The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. This system is to be constructed and located in accordance with the enclosed approved plans and with any component manual(s) referenced above. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s.145.06, stats. The following conditions shall be met during construction or installation and prior to occupancy or use: Reminders CpN01TI0 • A sanitary permit must be obtained from the county where this project is located in accordance with the APPRa requirements of Sec. 145.19, Wis. Stats. )FpT OF SAI • Inspection of the private sewage system installation is required. Arrangements for inspection shall be made with I the designated county official in accordance with the provisions of Sec. 145.20(2)(d), Wis. Stats. PROFES$IONA'' ►Npu • A state approved effluent filter is required. Maintenance information must be given to the owner of the toWvlsl®N OF explaining that periodic cleaning of the filter is required. Access to the filter for cleaning must be provided per SPS 384 product approval conditions. • All POWTS component piping material shall be SPS 384, Wis. Adm. Code compliant. J#?MS:E::~E CQRR • The area within 15' downslope of the dispersal cell shall remain undisturbed. Vehicular traffic, excavation or soil compaction is prohibited in this area. • 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. ,R 1 i, . . y 1 + t 6 WAI '1151, 13 Soo . t 1 . } + r" • , t i m 117 A 71 , 1 , try 1 # r' ~ . T J f -P i Glr~ST G o T' L ~.v..e. 0 0 Zp d s Rio rq F, 71t, ~C% N ° m eN Awl 70 ro f~T C► ~ • .Are ~ Q3 ca -r7 ~ Ofl Z till ;Zap o ~ ~ ~ Z 3 ~ M~ X33 W h SE BAR /AGE" i 3 ~ Q ~ G i E) N o r-- m o u es t> w i r rk 'f3 E D 'PI . 2, o -F 69 - • Ol D OF ~ n .t.,p DiSTRi~uT+o,u 1 A5letrSATEE G- G- , ri+i ck~s E's s pip aP TOP soiL rv/ 72F^/,/4Y- 6YsrE~M u" F°R r° E u, 96, yo L~•~ E H._ -OLL vu ~ F'©RM (p % S I o P E FM A~ ~ E I WATroo U,3 MP, tan 1 S. v0 fi f 0 Fr. - EtrEv~T'to~ S 3& t E Fr. lmvF-Rr of I Y 1ATGRA•(5 %-16 F FT. Z G - 5 t=r Top o F Rock { a if H 1-o FT. Top OF ( 14 IATERa IS 17.0(v ' _ PLAN VIEW OF MoujuD w-irti 13rD F_ND FoRm MAiN A Fr. P\j C, 13 5 Fr K 10 Fr 70 Fr w Fr 1.5 0 w -Fr 2 \19 o W as 12 F PVC. cAPpeD To t y" Ayg RElr- ossERVhrtao - P~pES /oc.;/`:aus : f l0 PRO H 't5-uD PERMA,JEOT MARk•EPS (TaPS - ®'F CIC,4.0 O j REGquiRED 13ASAL AQeA 'DA~'~y wttsre-Flow 3005 • ApAci rY sa. Fr. PRoposet, BAsM APe4 = ( A + ' o U 1 c S.+t r-T, r v 1 . . ` t n, pipe Distribution cell F x 6" 6" Cover material Fill ma"* lid (AST'Mt C331 fine 1 aggregate) Tilled area r.. <--Slope "Force majn ~ : , . Figure 6. Cross-section of a Mound System Water light cap Top 4" min. dia. of leaching Repair r~plings chambe r'Siot ~ ~ 6" 6" min. Infiltrative surface Water Closet Collar Bar Q18" 7"dia.). Figure 8 - Observation Pipes t ' t5 'A4 40/,,5 . ,44 41t If vj 71VAV rW G' 1 ~ Gam/ 1 c A c C C c. ST-4% C 33 rV ' P pipe Distribution cell Fill ma#eyal/- Coder material (ASTM G33 title } agyregate~ _-r 1 Tilled area <-Slope + Force tnagn Figure 6. Cross-section of a Mound System f Water tight cap 4" min. dia. Top of leaching Repak cb4lings chambe y.--Slot ~ C') . min: . ? Infiltrative surface Water Closet Collar Bar(3/8° min dia.) Figure 8 - Observation Pipes 0 7' ,o(4 K1'r, 7,70 4 'I ~e1 74) v c C iTZ STS C 3 ~ A T~~q Z_ r(~ it i Vii'/~ 50 P OL9 M Aa ~ T~ 1JE~T ~ ass Fr R 3.0 Fr n R~ E M /4i K3 X INcNE, << ~o Fr. Sc(~ , 1-0 Y °f PUG IucHE< LE C ZVAi.A(3CL TOTAL. V(91D VdIUNE Hot D .31, TD r4L. ANeTMR IX)c PN L. INc l{!=5 ~ . ~ ~ ~~4IS, MAMkPvLr> Z. FopcE. MAw Itvct{~S u~ .:#7. °F HOIES/pi PE 17 I.WVERT ELEVAT1OKj 4- o F- L ATe IQh I S .o SEE Pk-zUE P,3 i5 SIDE`Fp P, (o 70 17 E - W L-- PE FOR 4TE o R D PE W \ • RexiovE- All 5)Rill BURRS • NeIE S 10CA TEb o,J (3oT1'oM EqvAll1' SpAcED I)1 ST Ri Burlo" DISthARC>E RATE PO R fRch LgrERq C.. P s R t i S H. Z 2 TOTAL i7(STRiQ0TIoO -7i5cVi^Rc->E ATE %3 R f^oR 3r ►VET w OR K 2 2. q ~ ~ GAL M r',u • 57 ,N l'MUM ~l TL"RAL- CIO s, `ffvZ~) OF ,E,464, :t k ~4 II)b /3, o X Ll } /aUG 13411 vq /U,~ Y' } _ i . yam: ~ 19-rze.41 - Y,9w,v elo e4lp A ro!5'R47 rte. Z E,,OD -7 . SEPTIC TANK PUMP CHAMBER CROSS SECTION AND SPECIFICATIONS 4" CI VENT PIPE 12" MIN. ABOVE GRADE "WEATHER PROOF LO' FROM DOOR, WINDOW OR JUNCTION BOX APPROVED _AI . INTAKE WITH CONDUIT MANHOLE COVER FRESH C 0 4 6 R 5 W/ PADLOCK 9 II- - WARNI NG LABE I ll -,►r=- - ►1 4 " MIN . INLET GAS- J , T t TIGHT t A I S EAL APPROV ED 4o _i- I JOINTS W/ Lx 1> B PIPE 3' ONTO 0 ~ )_i 3v SOLID SOI L SOLID C SOIL PUMP OFF ELEV . - FT. RISER EXI'. Q,, D PERMITTED ON] ftN5i0~~ 1C"1 I IF TANK MANUFACTURER HAS APPROVAL 3" APPROVED BEDDING UNDER TANK C i CONCRETE PAD g~p.✓ ~ SPECIFICATIONS iE5 CON rEPTIC / DOSE 3• 'T'ANK MANUFACTURER: CO - NUMBER DOSES PER DAY: D . TANK SIZES: SEPTIC f&0 GAL. DOSE VOLUKE INCLUDING DOSE (Q 5 0 GAL. ,ZI FLOWBACK: GAL. ItYRM = ALARM MANUFACTURER: Z-6051 CAPACITIES: A = I2 INCHES Zoo GAL MODEL NUMBER: o hT SWITCH TYPE: =9- _ B = 2^ INCHES = 3 GAL PUMP MANUFACTURER: Z.OE*i : &O • C = J INCHES = GAL MODEL NUMBER: q y k4 / p SWITCH TYPE: ~i 1vA~ D = INCHES = 33Z- GAL REQUIRED DISCHARGE RATE 2- GPM PUMP & ALARM WIRING AS PEA~R}} ILHR 16.23 WA VERTICAL DIFFERENCE BETWEEN PUMP OFF AND DISTRIBUTION PIPE a' `0 FEET + MINIMUM NETWORK SUPPLY PRESSURE . . . . . . . . . . . . 3.Z 5 FEET + FEET FORCEMAIN X 1-31 FT/100 FT. FRICTION FACTOR 2~ FEET TOTAL DYNAMIC HEAD ~ FEET INTERNAL DIMENSIONS OF PUMP TANK: LENGTH _ WIDTH DIAMETER,---' SEE REV~r2SE S LIQUID DEPTH SIGNED: LICENSE NUMBER: DATE: P/C spEcs 'CAcl, I,, Of DEpi& -Q SEPTIC TANK, per Comm.93.44 (2) (c) shall be equipped with an 1 outlet attached approved filter device .(-Zabel PpLY'0~4 ti fliter). Tank shall have an approved above ground locking manhole cover for regular (every 12 months or less) inspection & servicing by a t D z vii 54„ AS 84„ X REQD m r. 43" z z m c m w y ,z . n O o UP 42„ 41, 4" CAS 0 m D m N 1 3„ 46j„ 5" j D a, , Z1 N C) - 38" m m rri \i v CS rn N UP 40" I , v 4" CAS c 4-4 0 m m ILJ z c O, 41" D D m N D . N m D r DO D ® C Z Z -I Z~ Do m D 00m D Q 0 O~z yaz A,OmpZmy00DN N px N~ao °m -0 mOp X ock Xx cF~N W o co O o mm m o rn n ~zc 1~1NC c NN -0 0 NC ~~c ~Fizaw Fig aa -0 O N ~v1c ~~tn ~D zC) N z 4 N1zm nDm - . 0 F M O r? a\. ~N z ~C~w?p., VCN1 F4 MUD 04 640 1 D O O OiA NmD I D (AQ) D NZZ Zm ON Np Dr v0. o v D N 0 -0 z 00 M~ m07 ~ 0 p V D O a o -n cz \ zZ Dqj~ p W D O m °n o O H y" c y An 00; Z :U my rn `S p O Om Z D un to n g m m N v n < 'a O m (n C X C 003 "O D 13-I n m m r~ m m 0 \ N WLP1000/650-MR m DRAWN BY. WCP SCALE: 1/4"=V-0" RE-POUR: ° SEPTIC MANUAL MISER iiiIIETE REV. z W3716 US HWY 10 MAIDEN ROCK, Vin 54750 DATE: 00 00 00 DATE:. POST-POUR: \ ° 800-325-8456 FILE: RMODO/W-W i M-nos/0001w :311A 95 8-5Z~-008 0 :anOd-lsod •:Mv" 00/00/00 :Mvo 09Lb9 IM N308 N30IVYV . OL .IMH sn mam z •n36 313811111 IdnNdw Oild3s „ o~ :anod-3ad 0-,l= b t :31V0S d0M :A9 NMdaO W MN-099/000WIM w z > j v coo w J w o w N d v m w d o (A d o U) Ov ~wo ~ Na v z w m Q w Z < Q Q o a z LLI F-- Q v Z~Q _z a w~ z 3 o Q N w J J= \ m O ee > (n a o w o °ow aa" aQ Cie a Q a o O O ui m cn w (50 z a o U) a~ In U o00 ~~m as au) Mo m0 zV z c o a CO LL e.\O~ d NH mww triri O Q'Ua- O O e r 0 ~ I Q F' W 04 00 p F (n FIIe F- O~ W W Ms aU Z~ Z; U1 N W U H~ IA m Z C7 Vl 0- ~ F O e ' 1- fn 0- LLI Fn M v , O (n o►- oQ~ ozo w w Q v w o w o __Y W mF= U (A Wt~l p>ZUZ0°J56 Ze Q Z~~ Q Z LLI ~O Z ~3m0 mLq~mm <.tc~ a~° o z v ono 25 Aw a• , Q J J C Q Z ~Lil z V O Z Z J O U~ J Q N N 1- Q W U l~ nZZ :D d- > ° a is a W sbo W I „ov do fi 1 > LLJ f W O „82 X ac m a - N LLI C) sdb 1 C, ..Zti 4cin °r Q tli I Of c Q M W M J Z "£t, m ab32i m a sv „f *9 Y z a • _ P5. s- f C _ ZOLLER EFFLUENT PUMP MODEL 98 NERD CAPA CUFivE 30- MODE .ss.. a 7/11 a f/~ A / 5/a 2s- - 3 5/f ia- e® + + e 4 a/1{ Ip_ a - 1 1/2-11 1/2 NPT ps. OALf ONS to so 4o 50 so 70 so ao p 1{0 240 Fi_o1N PER MINUTE tote olruttta N!A(yrtayrltti fu.nrtt ' II/ltNNl "a fwwm19NO ' CAPACIrt urettllartrl 17 a Ittt Malin! Q/tl I,t!! ! 1 it P13 t! 3,05 of 231 t! 4,1 IT 110 + 20 t t0 o Its !s locIt Val" CONSULT FACTORY FOR SPECIAL APPLICATIONS f ~Mcirlcei "9111810rs, tot duplex systems are available and fuPPlled VAh an slaint a Mercury ryoal Switches are avaNable for controltfn9 s r' klgte and Mad+enlcai ebarnatots, I& lax three phase systems. Without , Worm "chemaYelfms, era avallabls With of a Double piggyback mercury float awdchea are 'aveHable for variable level long cycle corpr013. Standard all models . Weight 39 ib1 /t H.P. 1. W optruad2PoMtO.chuJcalawMch,na*Oar* Contra, salaclton 04"01* P199A ctt marctrry Rod * or 404" control required. IM 1ltoda twhch. War to Fl~t77, AiOyblck mtlcury, Rod uto Afm6t elm bx Du laic 3. MechuacNaltanM a 100072 ar 10(07'1 4. &s fMorit. tar oarnct W04M of tltehlt ai Afarttlor, °E-Pdc"• e. {IlteurY aamo, Rod swNdr 10.0223 t or 1 t 7 duple j (3) as N) Rost tytlern N conhat actlvatar ,PKIh, t! t 2{ f :,::3 of 1 96 p _f :t1) /+ON ..d Pak f unceod b M Iq tar a"a't OMradwti to 0002. eann.c,bn tx w4 W In tlm• lo, wMerdom txwr.e__...w.pllel. 7" Mretaprr M yam, a Italle JONdrett hope to Cal" en C" nV'tton ett- ,110611; CAUTION Nut t Ita611i1 fMckkd ARamdcr itt01!!; W ~ a~ AN Neu aeA ,MW tont~ t1lilt { "t►d•NW. Ptdtge, !7; 11 fIAOrti; amt 9tmO, t" at.,M k aa,. fa+ /ya•,~ lees tna wh ;A1 i^! *-0" mead HdNna) f '*do ~'M Medea ahcuy e, tale ,watt ~i Hu (H MA Ad 101HA} Eq rta tn. f.eoupasa.ai lsrety anp RESERVE POWFPED DESIGN p For unusual conditions a reserve Gately factor )a dngineered Into the design o1 ,D rry e Zoeller - pump. t MAN 7ar.0. Box 16347 p t«a~~;ri.:xr w?56 OJI7 A/aaufac(uivIs 0!.. . J'Qr : rangy 70: 3 PO a' 11wors Carle tot /eTt xr #&,N Q~i,tirr)q/pS S'%Xr /3.& (501) taa•173a MOW) 174-3V4 POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page ~ of FILE INFORMATION SYSTEM SPECIFICATIONS Owner Ti6RR /00O al ❑NA 4,D w4 5 ~j Septic Tank Capacity Permit # Septic Tank Manufacturer (J t gF5 L-k- L"p • ❑ NA DESIGN PARAMETERS Effluent Filter Manufacturer RSL- -6(~ e,,~E] NA Number of Bedrooms 2.. ❑ NA Effluent Filter Model S~ ems. ❑ NA Number of Public Facility Units N ❑ NA Pump Tank Capacity s V al ❑ NA Estimated flow (average) 'el/da Pump Tank Manufacturer (,,V firs Lm ❑ NA Design flow (peak), (Estimated x 1.5) 360 al/da Pump Manufacturer ❑ NA Soil Application Rate al/da /ft2 Pump Model ❑ NA Standard Influent/Effluent Quality Monthly average* Pretreatment Unit ❑ NA Fats, Oil & Grease (FOG) 530 mg/L ❑ Sand/Gravel Filter ❑ Peat Filter - Biochemical Oxygen Demand (BOD5) 5220 mg/L ❑ NA ❑ Mechanical Aeration ❑ Wetland Total Suspended Solids (TSS) 5150 mg/L ❑ Disinfection ❑ Other: Pretreated Effluent Quality Monthly average Dispersal Cell(s) ❑ NA Biochemical Oxygen Demand (BODs) <_30 mg/L ❑ In-Ground (gravity) ❑ In-Ground (pressurized) Total Suspended Solids (TSS) 530 mg/L ❑ NA ❑ At-Grade ❑ Mound Fecal Coliform (geometric mean) <_10' cfu/100ml ❑ Drip-Line ❑ Other: Maximum Effluent Particle Size X in dia. ❑ NA Other: ❑ NA Other: ❑ NA Other: ❑ NA *Values typical for domestic wastewater and septic tank effluent. Other: ❑ NA MAINTENANCE SCHEDULE Service Event Service Frequency Inspect condition of tank(s) At least once every' ❑ month(s) JR ears (Maximum 3 years) ❑ NA Pump out contents of tank(s) When combined sludge and scum equals one-third (36) of tank volume ❑ NA Inspect dispersal cell(s) At least once eve ❑ month(s) ry' ✓ year(s) (Maximum 3 years) ❑ NA Clean effluent filter At least once every ❑ month(s) r ❑ NA year(" Inspect pump, pump controls & alarm At least once every: ❑ month(s) ❑ NA f ~I year(&) Flush laterals and pressure test At least once every: ❑ month(s) ❑ NA Other. 49 year(s) At least once every: ❑ month(s) ❑ NA ❑ year(s) Other. ❑ NA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: Master Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Servicing Operator. Tank inspections must include a visual inspection 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 to check for any back up orponding of effluent on the ground, surface. The dispersal cell(s) shall be visually inspected to chec{c>t e,efflulent level~n;tthe observation pipes and to check for any ponding of efflucritnon`,tk t?" around surface. ¢ ; The ponding of effluert oh the ,ground 'sunde' may indicate a failing condition and requirpsrithe immediate ngtifcatjon of the local regulatory authority.- " r~ k' . " . • • , When the combined accumulation of sludge and scum in any tank equals one-third (X) or more of the tank volume, the entire contents of the to tf shallQbederemoved by a Septage 4Servicing Operator and disposed of in accordance with chapter yNR 113, Wisconsin All other services, incjuding;but•not limited to,the,servicing of effluent filters, mechanical or;ptOsUOzed codh 'rlts,~prdMeatment units, and any servicing at inter'als f <_12 onthsshAll be performed by a certified POWTS Maintainer. " A service report shall be provided to the local regulatory authority within 10 days of completion of any service event. j START UP AND OPERATION Page of , For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other chemicals that + may impede the ptreatment process and/or damage the dispersal cell(s). If high concentrtitions ire °deteeted h~iy 'jhia contents of the tank(s) removed'ty'a septage servicing operator prior to use. ' ' System start up'stra}I fi®t oced;,when soil conditions are frozen at the infiltrative surface. During pow~i,outages.pftmp 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, overloading the cell(s) and may result in the backup or surface discharge of effluent. To avoid this situatro~i;h~ve the contents of the pump tank removed by a Septage Servicing Operator prior to restoring power to the effluent pump or capta"gt 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 par =JehiO 6v6r tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area within 15 feet down slope of,jg9y moend Qr•at-grade soil absorption area. Reduction or eliminat +n` 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) water; 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 SPS 383.33, Wisconsin Administrative Code: • All piping to tanks and pits 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 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 that time. ❑ A suitable replacement area is n9available due to setback and/or soil limitations. Barring advances in POWTS technology a holding tank may be installed as a last resort to replace the failed POWTS. ❑ 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 last resort to replace the failed POWTS. X Mound and at-grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative surface. Reconstructions 4such gstems must comply with the rules in effect at that time. <<WARNING>> SEPTIC, PUMP AND OTHER TREATMENYTANKS MAY CONTAIN LETHAL GASSES AND/OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS INSTALLER POWTS MAINTAINER o~ „~-._Q,Rfs Name N~ 'V f Name rW Phone `71 5 . 7 373 ZZ Phone 'j (5 • 76 3 • Q3 37 SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name S eVl- UErN 16 Name ST CRw. C'F , zD,u/1J G-- Phone 715-763- 33 Phone ?(y • 3S06 - ',,46 490 This document was drafted in compliance with chapter SPS 383.22(2)(b)(1)(d)&(f and 383.54(1), (2) & (3), Wisconsin Administrative Code. Revised 3/29/13 START UP AND OPERATION Page of For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other chemicals that may impede the treatment process and/or damage the dispersal cell(s). If high concentrations are detested hvtheacontents of the tank(s) removed ty a septage servicing operator prior to use. System start up'-stra}Iii t~ceurwhen soil conditions are frozen at the infiltrative surface. During powbF;.ou1age's.ptfmp 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, overloading the cell(s) and may result in the backup or surface discharge of effluent. To avoid this situatrop_1 ~ e the contents of the pump tank removed by a Septage Servicing Operator prior to restoring power to the effluent pump or co&itaet 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 pai• -4ehio 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 eliminat to 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) water; 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 SPS 383.33, Wisconsin Administrative Code: • All piping to tanks and pits 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 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 that time. ❑ A suitable replacement area is not available due to setback and/or soil limitations. Barring advances in POWTS technology a holding tank may be installed as a last resort to replace the failed POWTS. ❑ The site has not been evaluated to identify :.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 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 4-such systems must comply with the rules in effect at that time. <<WARNING>> SEPTIC, PUMP AND OTHER TREATMENYTANKS MAY CONTAIN LETHAL GASSES AND/OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS INSTALLER POWTS MAINTAINER Name Ne"Vj 11E Name Phone -715 • 7 ff 3 3 ZZ Phone -7(5- 76 3 • g3 37 SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name 5-tin)-e, /~f USN G Name ST cRor)~- G / 4- . ~jZo.ufu Cs-- Phone 7 1 5• 6 3 ,33 Phone -715 ' 38( • 76 ()0 This document was drafted in compliance with chapter SPS 383.22(2)(b)(1)(d)&(f) and 383.54(1), (2) & (3), Wisconsin Administrative Code. Revised 3/29/13 f FILTER. CARTRIDGE INSTRUCTIONS Installation STEP 1 Dry fit the filter case onto the end of the outlet pipe to ensure it is centered under the access opening. If not, then either insert more pipe into the tank through the outlet or solvent weld (glue) additional pipe onto the outlet pipe. STEP 2 While the case is still dry fitted on the outlet pipe, measure the length of 3/4-inch pipe needed to brace the filter to the tank end wall if utilizing the optional supplemental side support. If side support method is not utilized, proceed to step four. STEP 3 For installations utilizing the optional supplemental side support: solvent weld the 3/a-inch pipe onto the filter case. If side support method is not utilized, proceed to step four. STEP 4 Solvent weld the filter case onto the outlet pipe. Insert the filter cartridge into the case, pressing down until the filter locks into the bottom of the case. STEP S If a VRS switch is utilized: insert into the filter and lock by turning clockwise 900. Maintenance 1. The effluent filter should be cleaned every time the septic tank is serviced. 2. Open the outlet access opening to inspect the tank and filter. 3. Pump the septic tank completely, making sure to remove the sludge layer on the bottom of the tank and not just the scum and effluent. 4. Once the effluent level has been lowered below the invert of the outlet pipe, firmly pull up on the filter handle to dislodge the cartridge from the case. S. Slide the cartridge up and out of the case for cleaning. 6. If a VRS switch connected to an alarm is present, the switch should be removed by turning counterclockwise 900 and cleaned, with water only. 7. While holding the cartridge on its side (large flat surface facing t down) over the access opening, rinse off the cartridge with water -3 only, making sure all septage material is rinsed back into the tank.' 8. If VRS switch is utilized, replace by inserting into filter and h ` u turning clockwise 90°. 9. Insert the filter cartridge back into the case, pressing down until t: the filter locks into the bottom of the case. i'~ l0. Replace and secure the access opening on the tank. a [Materials: AoS Plasljc, Polypropylene, PVC, Stainless Steel Screws ,z~ ` T ~ { Model Numbers: MU-9101 ?1L3-9321 ML3-91161 HL3-9481 sP,`-~afi ML3-9251 ML3-9641 'Models . arifled by NSFrv io X" BEAR 0N5rW- FILTER CARTRIDGE - FIVE-YEAR LIMITED WARRANTY Bear Oiitt firs. cartriagas are wananld to be free of defects sn mabariai and worCman, hip fa five (5) yea, am a dare of co„a.,-.,er pumhase. BEAR ONSITE" alter Case-LrYeticae Limeioed Warranty Bear Onsite warrants the filter case wi"u be :rte of defects in matera3 and workmanship during 1o 1 ;se for thn period of fuze the original ptimhastr owns the pr-,ducG ;fa Qetect is round in nem-af use, Fear Omite will, at is elecxn, repair, previQe a rtplactnxnt par or prod- uct a; roatx 3ppropriaR adaustmert[. Damage So a Product caused by a¢iQtnL m'suse, or abuse is rmC covered by this warraaiy. Fmptaper care or malfumhons raubn from units not installed, operated, or enaintait>ed in accordarxe with 'inst-t- provide wilt -d the war- ranty: P!oof of pu: chase toriginal sales receipt) must be provided to Sear Onsite with all warranty claims. Bear Cxsite is not responsible for abor cFtargts, rema.ai charges, itstal[ation, or o irxidentat e7 mrs. auntiai cases. ?.n no event shall the liability of Sear Ceuta exceed tae purchase peke of, proQ:t:.t ,a "WW, - - ~ ' is ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner Buyer _qqi~_v P1 _(3 Mailing Address 3 3-7 '70 Property Addre /3 3 ~ ~ ' (Verification required from Planning & Zoning artment for new construction.) City/State R Parcel Identification umber o LEGAL DESCRIPTION o Property Location ,IVY 1/4 , Nw 1/4 , Sec. Sy , T Zq N R 18 W, Town of LO Subdivision Plat: Lot # Certified Survey map # S -I 1 , Volume l , Page 4 Warranty Deed # (before 2007)Volume Page # Spec house 0 yes 11 no Lot lines identifiable P yes 0 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 Si: 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. 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 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 true to the best of my/our knowledge. I/we am/are the owner(s) of the property, described above, by virtue of a waanty deed recorded in Register of Deeds Office. Number of bedroo a- v/ ATURE APPLICANT(S) DATE ***Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department. Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if reference is made in the warranty deed. (REV. 04/12) SHIN luflD uemsaleS/ialead a1sQ pasinad 6 AO 6 oN 13agS uoa soo -J( e A ano.idd IM`S.LN~fl02I ~ 1 '1 =9 Pte. 2I ;~w9wwo~es a~~e oa ~8 P FI iaafold 4IOZ/ZZ/90:31rG :A8 p3joagD AlJ'd3l `9WlOH -iaum0 SPH :A8 -a pling SJ311BA1 Sb60-86 :oK qof F~ oa z~ a~ C3 d o li 4. ml O xQ io io m a r- - " I I I `i ~ I I o I~ o _ w~ o 1 0, ~ "oo I x 4 ,b/4-,Sl I x o n 1 xa a n l ® ® m U N I I " ti~8-,bZ ~ q~Ol-,ll I I _ ~ I I I i L-,tt I 1 -m ~ I ~ I u94-.b oz_ a$ 30 n a 0 x Vl a A I' 3 Wis. Dept. of Safetklb~s SOIL EV L ORT Page of Division of Safety and Buildings JUN 15 2015 in accordance with SPS 385, Wis. Adm. Code County 5~• G,~O Attach complete site plan on~~p~p ~~~q jjqss than 8 1/2 x 11 inches in size. Plan must include, but not lirrafad, bfti~l4~~1 horizontal reference point (BM), direction and Parcel I.D. OLf Z _ f~. ✓ D • Z" percent slop] aE (Q;Q"5N;]w, and location and distance to nearest road. Re ed by Date Please print all information. Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Property Owner Property Location q rE2 R•?/ DIME Govt Lot N G 114 1/4 S ,5 T.2 N R E (or~ rty Owners Mailing Address Lot # Block # Subd. Name r CSM# Prope ~ cl /337 70"i A015. Cs,~! ~87' UOI 317LI City State Zip Code Phone Number ❑ City ❑ Village Town Nearest Road QoC3~RTS l~l. SgOz3 (~a51) Z!O.35Y? WAImeN C76 *14 AVe . .Z. New Construction Use: ~ Residential /Number of bedrooms Code derived design flow rate GPD ❑ Replacement ❑ Public or commercial - Describe: Parent material Flood Plain elevation if applicable ft. GD'z.S (DER F 1►J elZ 5cc}}S o~u A it y General comments pEl~ S>E 9 AIC1 h, V11-5 and recommendations: Area Spot Tested suitabWtor a . f, /yp G ~.v 131d j I Bep~PM mound (P.O.W.T.S.) system using T ZSAT~v W i f, D f;i r-i5 rand till, F] Boring qS. J " ❑ Boring # Pit Ground surface elev. ft. Depth to limiting factor 2te in. Soil lication Rate Horizon Depth Dominant Color Redox Description Texture Structure onsistence Boundary Roots • GPDIt2 in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. ff# 1 1 r D .1 Z i© YR -Ti of s bk N-P R cs '2-f z !x• 18 /W R CS ! . G . 8 tb R5 iG Z fseK 5 iR 5 S~- l R rli~n f p, G 7 a.SyR 5 g w. 141 9 • 4 Z. Boring F Boring # • ❑ Pit Ground surface elev. ~ 3 ~ ft. Depth to limiting factor Z ~ in. Soil Application Rate Horizon Depth Dominant Collor Redox Description Texture Structure onsistence Boundary Roots GPD/ft 2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. ff#1 ff#2 / D-. o 10 YR 3~2 5~~-- Zf 50K rM F rz C $ Z f . CQ • 8 1 f . ~ /0 -Is 0 Y/Z 516 PZ_ fsbK. (A4 -PR C.5 3 15-28 7.5YR 5 SG I-~ R nhfK q . 7 ~l a-37 1.5 J .R C l M o f S •.5 L.. o W nM~ i . Co a• S y9 c~ 8 Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BOD s < 30 mg/L and TSS < 30 mg/L CST Name (Please Print) Signature . CST Number ROSERT U-6RiCk1_ 00(__ ZZ6375 Address Date Evaluation Conducted Telephone Number 2-917, l D Ua . SPt~t~S U li-ey 4 Si'7(*7. AM L 1 g- ao 15 TS -7-7,;Z Z SBD-8330 (RI 1/11) dewy 90IM& 200 2- 3 Property Owner Parcel ID # Page of F3-1 Boring # D Boring ~j/ Pit Ground surface elev. ✓ (D ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure onsistence Boundary Roots GPD/ft z in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. ff#1 * ff#2 10- 9 /o YR 312- 5!L Z >w► SbK nn~-f 5 f . (0. .00 Z /2 /o YR 312- S~[. 2f R nn f ~Z G 5 I . ~o , 00 3 /2-AP !AYR 5 S/L 2- f56k rM-FR cW 41 (•Z5 7. SyR. S - 5L /•F5bK . m fP. Cw - , 7 S 5.3 7 s R ~ r; n ~vo fs 5CL /-F sdk l►n -f- i - 'Z .3 YR ❑ Boring# E] Boring 4k qr 5. 4, 7 J~ S pit Ground surface elev. ft. Depth to limiting factor / in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure onsistence Boundary Roots GPD/ft z in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. ff#1 * ff#2 / o• y /oYR 212. ofs bK rm f 9 a 5 Z `I'10 loYR 2/3 Nn Arof ; ,571L 2M, rMf f as . o Z z. 5 YX 3 X0.2.5 1.s R s~ a r4o1-5 5cL ~F6 6K /M P 2 ,3 J ❑ Boring # F] Boring pit Ground surface elev. ft. th to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Te re Structure Consistence Boundary oots GPD/ft z in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. * ff#1 * ff#2 5 iA-L OTE AV MP l 4,f,5;0--5 OF oiL tTS ~f 5 firms f!-RE To t1. vU hcc X i3 PoR >J l -I v m p 5. 5 T til 15iVC,5- ML 4L- 'A ^ AdRi-ZW-9 A) 50ILS I~0 No7- M~t:r rt t- A-+,f RU L-&--s . * Effluent #1 = BOD 5 > /0<220mg/LandTSS>30<150mg/L * Effluent #2 = BOD , < 30 mg/L and TSS < 30 mg/L The Dept. of Safety and Professional Services is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, contact the department at 608-266-3151 or TTY through Relay. SBD-8330 (Ri 1/I I) Property Owner (Z ?-I ME Parcel !D A 5Z) Zoo Page Z of 3 # 7 Boring # ❑ Boring Pit Ground surface elev. 5(p ft. Depth to limiting factor 2 5 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure onsistence Boundary Roots GPD/ft z in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. ff#1 * -f#2 YR 312- S!L 2-W sbk t1'2 e s 2- 2- / 2 /b Y2 312- S/L. 2f R ,rn f G 5 00 3 1 12 -Ap /0 yR 5 5/L Zf 56k nri f R C W - .00 k6 •25 sy2 5 5L /fsbK . /Y4 J2rz Clu - , 7 s s 3 7 s YR 40 C IP ~ofy 5cL /-F 6k~ -f- ; - - , z , 3 ~2, s yR ❑ Boring # Boring q, 5. (%P, ❑ 41 Jam, ,57 , ,s . Pit Ground surface elev, ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure onsistence Boundary Roots GPD/ft s in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. * ff#1 * ff#2 y /0 YR -212- 6, Ifs bK f p C9 Z /o ~o YR 213 M, ► M o f s Si L 2 nn r>h F i r-r. s - . o . Z z. s YX (e/oo 3 ~0 25 15 51& a , Jyof5 5 CL F,5 Ae F~' Z - Borinn 3f ❑ Boring nnn ❑ Pit Ground surface elev. ft. pth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Te re Structure onsistence Boundary It ots GPD/ft 2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. ff#1 ff#2 V SPA r~L oTE AV lD l .4i2L=,- 5 0 ~ of C. co his ~"RE Te ,u A•cc A13 F-oTZ U A.) L) 5 S 7"2~--A-f Si~uC,i=- (l A- Al'. 46R- SUS A b- M j f 50![.5 no Not' Me7t:r T-~L- A+ RuL a-s , * Effluent #1 = BOD 5 > 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BOD 5 < 30 mg/L and TSS < 30 mg/L The Dept. of Safety and Professional Services is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, contact the department at 608-266-3151 or TTY through Relay. SBD-8330 (Ri l/I I ) \ I GVES j" o T z iiNL c 'o a F t _ / FE ICI G, rz~ 3(e, 17 0 R ~ ~n i UY, z v~ V~ ~~Fy % L D 7' L /NE L D j ~jC w -L -o c D a s s p a INA .y\ O ° ~ ~ ` O ~ o ~ Va LI'S GAR46-E ! ttM , r✓. +Am CA a G ~ p ~ Z Q R~ U's /7- _ CIA r R4 i z• ~ c d r m a z 11 ~ X11 lr1 ~ ~ -n --i O 1 ~ 1 ~ c l v ~ C L O 1 O 1 ~ c N Lot 3 and 4 CSM 11-3149 042-1098-50-200 s 777-171,717- ta~ X 491 a 5 r r h f Y4y ..1{f~'~ '-•~d1 _ Yoh ~ $ ~ _ kx ^ 1'P~ ,.,tom{'. 4, . ~1p?~-1 1SE F c~ 1 ~~'r. Legend ~ ectians P F uartea: 0T8xParce1s_Fnat2015 {3 2010 aerial RGB 1.. ~ lted: Band_t Green: Band_2 :N JBWe: Band-3 Drainage Streams k -Dam Perrenial Stream IntemMtent Stream Q Lakes IMPORTANT NOTICE Melly 06/15/2015 THESE MAPS ARE NOT SURVEY MAPS. THEY WERE COMPILED FROM THE PLATS AND DEEDS ON RECORD WITH THE REGISTER OF DEEDS OFFICE AND IN NO St. Croix County Community Development MANNER REPRESENT A FIELD SURVEY. THEY SHOULD BE USED FOR REFERENCE PURPOSES ONLY. 0 60 120 240 Feet Real Property Description (715)386-4671 1 1 1 1 1 1 1 L _j o ti p C5 I h ~ 0 o c I ~ I o I ~I N I ~ O I ~i C I ~ I ti I I I U z C Li c 0 3 a I I v co Z c € o v z I Lo N W d m M I- Z C I `z t o U) H Z v r> ~ I o 0 Q Z Z o I o a 0 N Z aci N y (D 04 CL 0 L I V) U) bap z M L z o •N ~a a aaa z m y a r i aD I o N ' o } co co N J V rn rn o v o I ° a I s ma D ¢ Z Fo m cv) °o o to c o v E Q o EE °Cy y a o f U? O T m C 'd N N l cO F v~ C ~a I v Q OD C C N N N yN N 'C uJ C N r •O f- 00 I N 04 0 0) -C ca • O M U M CD Z N z rd U) `Iv o u c a d` 49 c r~ Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT . Page of LaboFand Human Relations Division of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code COUNTY 00 Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or # RFc dimensioned, north arrow, and location and distance to nearest road. [ k- APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION r- f iiy WED Y DA 03 PROPERTY OWNER: PROPERTY LOCATION ST CRC T 1p ZO ~GvLS GOVT. LOT _ 1/4 w *J'4nIR- Ik& PRO IEATY OWNER':S MAILING ADDRESS LOT # LOCK # S BD. NA fCE a. a y r s CITY STgTE L ZIP CODE PHONE NUMBER ❑CITY ❑VILLAGE OTOWN E T [ New Construction Use [ /J Residential / Number of bedrooms Addition to existing building Replacement [ ] Public or commercial describe Code derived daily flow 60o gpd Recommended design loading rate bed, gpd/ft2 trench, gpd/ft2 Absorption area required "6 ' bed, ft2 - trench, ft2 Maximum design loading rate bed, gpd/ft2 trench, gpd/ft2 Recommended infiltration surface elevation 6. (s) ~ y ft (as referred to site plan benchmark) Additional design / site considerations £,E /ftPt4lV0 313 Cegefe 7?, ffe~'C.rl~ ~e4EL ®51,~~L~' ,gip fafent materie &Eft ,ftZZIA 4r 4dK AE ,4s G~'r~c,CFlood plain elevation, if applicable ft S = Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE 7 AT-GRADE SYSTEM IN FILL HOLDING TANK U= Unsuitable fors stem ❑ S [Z1 U 4S ❑ U ❑ S O U ❑ S o u ❑ S O U ❑ S o u SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Botrtdaly Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Tirench k? r 0-y '(Q SZL AA 5,6,k AdjcA S S C.S .1 3 Ground ~•S - S L . 8 elev. &.,/f t. - - VIZ- 2- v L - - Depth to limiting factor Remarks: Boring # o-z m- 3 ~¢S Ground - v -Z • Z elev. Depth to S - o o, S S G L limiting factor Q3. ~y Remarks: CST Name:-Please Print Phone: t - 6f rl -P. Address: i?4 4J Signature: f Date: CST Number: L i 2 --J PROPERTYOWNER M VRO~ Cs~GVLFS SOIL DESCRIPTION REPORT Page 1 of _ PARCEL I.D. # Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Barr Roots GPD/ft in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed Trench Ground ;3 L 2F .53A PA F S , elev. _ M2- 1~~~ ft. 2 L Depth to limiting factor Remarks: S~TGI/ZA~T~~ f}'T Boring # I 2 0 -3 3 L S v Y r 41 1/ Ground _ 8 Ls V FRG s elev. ~X/ - g s 2 s L ft. c Depth to limiting factor Remarks: Boring # .4+:nvtS:iiii.~ •i Ground elev. ft. Depth to limiting factor Remarks: Boring # k Ground elev. ft. Depth to limiting factor Remarks: SBD-8330(R.05/92) 3 ~ N ~ `0 ~ A A g A n ~ O o h o m 1 0 3 yl 6 h ~ p Its m G Q a All `i z ~ ~ Parcel 042-1098-50-200 01/09/2006 11:07 AM PAGE 1 OF 1 Alt. Parcel M 35.29.18.5446 042 - TOWN OF WARREN Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co-Owner O - HOLME, TERRY W & RACHEL R ROSS- TERRY W & RACHEL R ROSS- HOLME 1337 70TH AVE ROBERTS WI 54023 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description 1337 70TH AVE SC 2422 ST CROIX CENTRAL SP 1700 WITC Legal Description: Acres: 8.900 Plat: 3149-CSM 11/3149 SEC 35 T29N R18W PT NE NW BEING LOTS 3 & Block/Condo Bldg: LOT 1/2 4 CSM 11/3149 8.90AC Tract(s): (Sec-Twn-Rng 401/4 1601/4) 35-29N-18W Notes: Parcel History: Date Doc # Vol/Page Type 03/08/2002 672983 1850/128 WD 04/29/1998 578111 1319/001 AF 11/05/1997 567974 1274/515 WD 07/23/1997 2001/380 QC 2005 SUMMARY Bill M Fair Market Value: Assessed with: 79819 314,200 Valuations: Last Changed: 10/23/2001 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 8.900 60,200 193,600 253,800 NO Totals for 2005: II General Property 8.900 60,200 193,600 253,800 Woodland 0.000 0 0 Totals for 2004: General Property 8.900 60,200 193,600 253,800 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch 311 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 a r ~ f COUNTY TONING OFFICE R ' As-built Plan For An t 1-site Sewage System e. r-, , f Date of installation - Permit number State p 't~unberc ul0 Owner ti Address /k - 3,4 1A"Sec, 33S`T-2q N-R~ Town of L .v . . r t= N Parcel Tax Number ©y -1o Q 9-. -ez---2e a Lot Block Subdivision/CSM l Y`l Urn l/ 3/y~ Description of benchmark ac. Elevation Alternate benchmark Elecv ti v B )WOW *NOTE: Use filed readings and incl de benchmark read g for each group of readings. 0 7, SEPTIC PUMP TANK HO . ING TANK INFORI) . ,,ATIO, i ST 3Ai~ n o ' Manufacturer Lll iie ST\PC o o/~~ ~f> Setbacks: House ,3Well P/L Pump manufacturer 5`' - a~ Model -Ile * Holdin in'ly 1ce Road/Road Vent to fresh air inlet Water Supply Setbacks: rv Meter locati Alarm 1 'on &OIL ABSORPTION SYST Type of system Width _ Length /00' Number of trenches Setbacks: House ;;";z a W Well ti~ .;ILLt4p/L co'Vent to fresh air intake -2 oo ELEVATIONS: Building Sewer II) ST Inlet ,fro i 5 ST Outlet Y,/ PC Inlet 9.3 -;Z 3 PC Bottom PC Pump off Header/Manifold le' a 3 Be,t )rn System z Final Grade le -3, Y,y ' Top of Manhol S PC 73 Top of Distribution Box Distribution Lines NOTICE: Please provide the following: A plan view sketch showing everything within 100 ;~et of the system ON THE REVERSE OF THIS FORM. Two horizontal reference points to center of septic ,-.ink manhole cover. Plumber signature License numbers Date 7 - 3-~~ S~•C~i k C: r ::°UNTY ' j As Bwlt Salutary ' <ystem Report PLAN VIEW Show everything within 100 feet of syste . / 7 129 23 .__V._ 3~- yea INDICATE NORTH ARROW Wy~,sl!!~i Department of Commerce ``Safety and Buildings Division PRIVATE SEWAGE SYSTEM CountvST . CROIX INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Sanitaribe, 14Np.: Personal information you provice may be used for secondary purposes [Privacy L s.15.04 (1)(m)]. Permit Holder's Name: a i Pillage Town of: State Plan ID No.: COWLES, MYREN R. RN CST BM Elev.: Insp. BM Elev.: BM Description: Parcel NY--:1098-50-200 TANK INFORMATION ELEVATION DATA A9800132 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. eptic cA) -•2e $2.S lZ© Benc •-7 DO • I" -ieG 0 o i~1 3 8 1~.8 ® loc~E "Do Aeration Bldg. Sewer l0.(0/ l oa. Holding I Inlet A40 TANK SETBACK INFORMATION „ p n~ S lit Outlet Co/• q I TANK TO P/ L WELL BLDG. Air Intake ROAD Dt Inlet H, ! 8 ,a3 ' ep Ic "161 ril k 3 NA Dt Bottom ict 3 sg Dosing NA Header/Man. Aeration NA Dist. Pipe 10.78 10.75 lo.2.3 Holding Bot. System J! y3 /d/-~~ PUMP/ SIPHON INFORMATION IQ X2 vL Final Grade Manufacturer Demand cw.~ 71 Model Number 3,j GPM L 16 37W lo? TDH Lift, V-l Loss Friction Sy1aerrr~ TDH/(, t I r Hf Forcemain Length d)_;S' Dia. 7," Dist. To Well SOIL ABSORPTION SYSTEM QPTTRENCH Width Length r No. Of Trenches PIT No. Of Pits Inside Dia. Liq 'd Depth DIMEN I N 5 UV DIMENSIONS SYSTEM TO P / L BLDG WELL LAKE / STREAM LE RING Manu a I SETBACK CHAM INFORMATION Type O o e Number: System n NO 23d OR UNIT DISTRIBUTION SYSTEM Header/Manifold Distribution Pipe(s), 1I P x Hole Size x Hole Spacing Vent To Air Intake Length 7 Dia. 2 Length 46 Dia. Z Spacing '14 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 C] No % COMMENTS: (Include code discrepancies, persons present, etc.) •3 O.35 3 ' LOCATION: WARREN 35.29.18,NE,NW 1337 70TH AVENUE 100'5S loo R24=1 q AL4. f=ro p 0,W eteiy 5eWrr Plan revision required? ❑ es No 1 Use other side for additional information. 2 ~L 9 l `j SBD-6710 (R.3/97) 7 1,x4 h~ Date Inspe or's Signature e . No. Safety and Buildings Division A. SANITARY PERMIT APPLICATION 201 W. Washington Avenue Isconsin In accord with ILHR 83.05 Wis. Adm. Code P O Box 7302 Department of Commerce Madison, WI 53707-7302 • Attach complete plans (to the county copy only) for the system, on paper not less County 54.( than 8 1/2 x 11 inches in size. ` x • See reverse side for instructions for completing this application State Sanitary PPeejrmit Number Personal information you provide may be used for secondary purposes ❑ check if revisiffi ctop~ious application [Privacy Law, s. 15.04 (1) (m)]. State Plan I . Number 1. APPLICATION INFORMATION -PLEASE PRINT ALL INF RMATI N°l Propert O ner Name Property Location y t- eh e l~S Ale 1/4 W 1/4, S ~ T , N, R g E (cCW~ Number Block Number Property O ner's Mailing Addre s L j Aff 3 1 IF -2 T1 City, State Zip Code Phone ;umber Subdivision Name~or LSMFur~ er l I j ~ ~w_~N O It. TYPE OF BUIL~CH N : (check one) ❑ State Owned ❑ it Nearest Road ❑ VI age Public 1 or 2 Family Dwelling - No. of bedrooms A/ own OF III. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s) 1 ❑ Apartment/ Condo 3 , ;;?,g , `F, 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. 1 lew 2. E] Replacement 3. E] Replacement of 4_ ❑ Reconnection of 5. ❑ Repair of an ---System System _ Tank ----ly______________ 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 Pre Distribution Experimental Other 11 E] Seepage Bed 21 ssureMound 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: 1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Perc. Rate 6. System Elev. 7. Final Grade ~U Required (sq. ft.) Proposed (sq. ft.) (Gals/day/sq. ft.) (Min./inch) ~0~ °d Elevation S-0 0 S7 C) Feet /t,3,9.2- Feet TANK Capacity VII• FORMATION in gallons Total # of Prefab. Site Fiber_ Exper. Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App New I Exist in tructed Tanks Tanks r Holding Tank f Csn !`l9 I P m iphon Chamber Vill. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage s stem shown on the attached plans. Plumber's Name: (Prin Plumber's Signature: (No Stamp) MP PRSW N Business Phone Number: Plumber's Address; (Street, ity, State, Zip Code): Cry " Q IX. COUNTY/ DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (includes Groundwater ate Issued Issuing ent Signature (No Stamps) A roved S charge fee) ql 171,7 A pp ❑ Owner Given Initial Q L Ice Adverse Determination ` 3o/A X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SBD- 6398 (R.11I97) DISTRIBUTION: Original to County. One copy To: Safety & Buildings Division, Owner, Plumber SAFETY & BUILDINGS DIVISION 201 E. Washington Avenue P.O. Box 7969 isconsin Madison, Wisconsin 53707 Department of Commerce Tommy G. Thompson, Governor William J. McCoshen, Secretary August 29, 1997 ULBRICHT & ASSOCIATES ROBERT ULBRICHT 655 O'NEILL ROAD HUDSON WI 54016 RE: PLAN S97-02810 FEE RECEIVED: 180.00 COWLES, MYRON NE,NW,35,29,18W TOWN OF WARREN COUNTY OF ST CROIX MOUND SYSTEM The Department has reviewed the above-referenced submittal. Conditional approval is hereby granted for the system plan submittal. All noted items must be corrected. The review and approval of the system is based on chapter 145, Wisconsin Statutes, and chapters Comm 83 and 84, Wisconsin Administrative Code, and is contingent upon compliance with any stipulations shown on the plans. This system has not been reviewed for the code requirements set forth in chapter Comm 82 or in chapters ILHR 50-64, Wisconsin Administrative Code. This plan submittal approval will expire two years from the approval date, or if a sanitary permit is obtained, plan approval will expire on the day the initial sanitary permit expires. The licensed plumber responsible for this installation shall keep one set of plans with the Department's stamp of approval at the construction site. The installer shall notify the appropriate inspector when inspections can be made. All permits required by the city, village, township or county shall be obtained prior to installation. Inquiries should be directed to me at the number listed below. Please refer to the plan number shown above. Si erely, u' ~fiames Quinlan Plan Reviewer Section of Private Sewage (608) 266-3937 5859R/ 1 SBD5524 (R.07/96) ULBRICHT & ASSOCIATES CO. 655 O'Neil Road • Hudson, WI 54016 Reg. Designers of Engineering Systems 715-386-8185 Private Sewage Consultants PROJECT INDEX DILHR Plan I.D. # S97-02810 Date Aug. 29, 1997 Owner Myron Cowles Phone 715-425-7786 Address P.O. Box 339, Roberts, Wis. 54022 , Legal Description Lot. 3 CSM 548744, Vol.11, Pg.3149. Tax Parcel # 042-1098-50-200. Former owner: Brent & Patty Robertson. NE, NW, Sec. 35, T29N, R18W. Town of warren County St. Croix C.S.T. David Fogerty CSTM3233 Installer Local Authority/ Supervision St. Croix County Zoning Dept. PROJECT DESCRIPTION Soils are permiable (.5/.6 GPD/Ft2) but seasonally saturated at 49". A long narrow mound system using 12" sand fill is proposed. New Construction. For a proposed 4 bedroom home. Estimated daily wasteflow- 600 gals. RECEIVED P.O.W.T•~• AUG 2 9 1997 , Conditionally SAFETY & BLDGS. DIV. ptir COMMN ~~~~•~1SCONSj~ BRICW 8EE;5s BOSON. Pg.l PLOT PLAN VIEWS r~,r~arrnnminuaa~~`~~~ Pg.2 SYSTEM CROSS SECTIONS & SYSTEM PLAN VIEWS Pg.3 PIPE LATERAL LAYOUT Pg.4 DOSING CHAMBER CROSS SECTION Pg.5 PUMP PERFORMANCE SPECS (v c~ tai • y ~ W chi ~ c n bl) W T~ d rn d ° ~ NON i \ N C-S ell oll N ,.g .10 a ~ (o 10, \ i N EPOSS SECT10k) of MoooD wi rti BBD BED F I VA ro ' 'DIST(ti(3t~T% oN Ay9ec5gTE G- I TNiGk-a E5 3 pip ~N G- sysrEM OF 'r0P soi L E 1 Evti rioAl D' U)Ji FopM To E, ,u H q~O Cv RATIO w/l PI ED T o p V N i Fd RM % SiopF- FMh Et~I~llT~oa (~uoER BEV 100.&0 o FT, Et_EVI4r~o►J S t E 1.2 Fr. INVERT' -OF 2 IATGRA(S L Oz .I F •82. FT ToP o f R ock G. 1.0 FT. L lo2.Z.5 H 1.5 FT, • Top OF 2- IATERAIS PLAN VIEW vF MOULD - wiTtf 13ED . cEortAvC FORUZ MAiXJ A s Fr. 1040 Fr I K 10 Fr 4 Iz o Fr %T T w Y w 27 Fr ~ Bev ~F !12- To PVC. cAPP6b 1 '-n • rc L) I y k) E TWO R K P - - . - -r 1 - _ 13uTlonl LAT~RAIS lRov SAP S x y X X i PVG FoRCE MAW LAST IAO I E -SH II [3E NE~.r Td AND SAP 25 Fr. VOID VoluhE FOR gaffs. d F Z Fo RcE MM" q-1 *.u~~.Rr ~ IEvAr~o~ TOTAL v OI v" E OF' 4y,0 Sias . f ERFORAVED (PIPE D.ETai L 401E9 10CATFU o,u G o-rrom SH All Be I_ 'I VARiA(SLEF y EG2 V hll~~ S~hGEp • . Y o1sr~NCE HaIE Di,lNK TeR I~• I MANI FOLD " I►, . X r,, r-oRct= MAIN Y Z! - - I~vcI,ES or- liole5 HEAD CAPACITY CURVE 3 7/6 1/4 30 MODEL "9H" 4 6/8 e a 25 4 3 5/a 20 6 ~ W , + + 15 1 O 4 6 4 3/la to 2 1 1/2-11 1/2 NPT 5 0 U.S. GALLONS 10 20 30 40 50 BO 70 00 LITERS 80 160 240 0 FLOW PER MINUTE TOTAL OYNAAW NEAWLOW PEA twouTE EFFLUENT ANO OEWATEIeNa CAPACITY 12 NEAO UNITanAitt • , - •v FEET METERS OALs t(AS 5 . 1.52 72 213 10 2.os el 231 + Ib 4.57 45 170 20 11,10 26 95 lock Veke 23' CONSULT FACTORY FOR SPECIAL APPLICATIONS • Electrical alternators, for duplex systems, are available and • Mercury float switches are available (or controlling single and supplied with an alarm. three phase systems. *:.Mechanical alternators, for duplex systems, are available with or • Double piggyback mercury float switches are available for without. alarm switches. variable level long cycle controls. SELECTION GUIDE Standard all models - Welaht 39 lbs. - V, N.P. 1. Inlegrat boat operated 2 pole mechanical switch, no external control required. 0E series 2. WpM Piggyback mercury float switch or double pl7gyback mercury, float Control Selection switch. Refer to FM0477. Model V be-Ph Mode Am a Anl&ex Ou lex 3. Mechanical alternator 10-0072 Or 100075. M9a 115 1 uto 9.0 4. Sea FMO712, for correct nadel d Electrical Akeinalor. " E•Pak" Noe 3of4&5 6. Mercury sensor float swilch 10-0M ueed y a control activator .pecVV 000 230 1 4.S duplex (3) or (4) foal system. 230 1 Nan A s _ { fqur.111 We " t Pak I-'" a.. t PUMP CHAMBER CROSS SECTIOU AND SPECIFICATIONS P,44E of 5 VEUT CAP 4'•C.I. VEf,JT PIPE WEATHER PROOF APPROVED LOCKING JLIMCTIOAI BOX MAIJHOLE COVER 25' FROM DOOR, w/ ui~ij(,tlJ,u(! /A13El WIIJDOW OR FRESH I2"/II11' I AIR IMTAKE i ~r17/0 111 GRADE I 4" MIM I 4 /00 CONDUIT- 61 ~I~U~rn oti ~ 111 = ygo PROVIDE I IIJLET AIRTIGHT SEAL I III V 196 I III APPROVED JOINTS APPROVED JOINT A K .I II W/C.I. PIPE 1J/C.I. PIPE INS ~cN `v~ I III E%TEAIDING 3, ZXTENDIAIG 3 ~0~ O I II ALARM ONTO SOLID SOIL O/JTO SOLID SOIL B S,~ 50 ow C I ELEV. FT. 1 PUMP----- OFF J OiQ 1 ~1o~PE eF ~ptpplA) 6- D ~.7 K Sil~vl> N k D 1 BLOC ~j-- ~cc IE VA f RISER EXIT PERMITTED OIJL9 IF TAIJK MAUUFACTURER HAS SUCH APPROVAL i SPECIFfCATIOKIS SEPTIC E {,p DOSE ~t-=-~5 PER DAS TA►JKS MAIJUFACTURER: IJUMBERI.0 DOSES: TAI.IK SIZE: dd- GALLOMS DOSE VOLUME l~ GALLONS ALARM MANUFACTURER: ,(U /T/~ Ik1CLUD1AIG BAGKFLOW: MODEL IJUMBER: L CAPACITIES: A= 2 INCHES OR 7 GALLONS SWITCH TYPE: MEeCyI~. t B= INCHES OR If( GALLONS PUMP MAMUFACTURER: zd~!!~jC=INCHES OR '`I5 GALLO►JS MODEL IJUMBER: c /Z ~ p D=20' IMCRES OR `Tb GALLOWS SWITCH TYPE: r p~~K AIEK' ~IO~r MOTE: PUMP AMD ALARM ARE TO BF p<<SY 22 cc IAISTALLED 0" SEPARATE CIRCUITS MIIJIMUM DISCHARGE RATE - GPM G~ fiANk 5~,1=GS VERTICAL DIFFEREMCE BETWEEU PUMP OFF ARID DISTRIBUTIOM PIPE.. FEET rAA _ + MIMIMUM METWORK SUPPLY PRESSURE . . . . . . . . . . . 2.5 FEET 6AG(A - 0-5 -4- ZS FEET OF FORCE MAIM X ~ F/oortFRICTIOIJ FACToR..•s2- FEET tgOAIS 2.0 9. Z Ads. TOTAL 09MAMIC HEAD & = FEET r~ ~tIOAJfl I ( 50 IMTERAIAL DIME,"SIOMS OF TAUK: LE-M&TH ;WIDTH ;LIQUID DEPTH A Wisconsin; Department of Industry, SOIL AND SITE EVALUATION REPORT Page ~of-7 Labor and Human Relations Division of Safety 8 Buildings in accord with ILHR 83.05, Wis. Adm. Code ' . COU ~ Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but 0% not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or P ` I.D. # FCEIVCp dimensioned, north arrow, and location and distance to nearest road. APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION D A'YA 0 3 JlQgrE PROPERTY OWNER: PROPERTY LOCATION CpON~ 3 6iv 0 p GOVT. LOT 1 /4 Gtr 1/ G UI~1C,L PROPERTY OWNER':S MAIL AG ADDRESS LOT # BLOCK # SUED. NAME 8 CAF E4 CITY, STATE ZIP CODE PHONE NUMBER ❑CITY []VILLAGE MOWN NEAR O- 4!5'LE7v dd C tv~ - l) O Tom' - [/J New Construction Use[ ] Residential / Number of bedrooms y [ J Addition to existing building j J Replacement [ ] Public or commercial describe Code derived daily flow aO gpd Recommended design loading rate bed, gpolft2 trench, gpd1ft2 Absorption area required SDc) bed, ft2 trench, ft2 Maximum design loading rate bed, gpd/ft2 trench, gpd/ft2 Recommended infiltration surface elevation(s) 4,9.2, j? r It (as referred to site plan benchmark) Additional design / site considerations Parent material Flood plain elevation, if applicable It S = Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK U= Unsuitable fors stem ❑ S m U OS ❑ U Os O U ❑ S O U ❑ S U ❑ S JO U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Bonday Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench >:.>:::::;:e-9 /v 13 rL 313X MFX 14S ~7_ .6 Ground 2 - Z.9 X;4 2,M YAX N ES S • 3- • d elev. - 1 / It. 3 p-5-d- z Z;- - y S 47 z- . 7 ' . Depth to Y 5- -(0 Z. - S p limiting factor F~ ,y Remarks: Boring # 412 _TC 53.4 /M FX 4S r G 7c S43/t AA e~z_ C ♦....w.v:iht:i: Ground L - 3 elev. Depth to limiting P~ factor Remarks: CST Name:-Please Print / gce T, Phone: SG Address: D Gc t2= p-2 Signature: Date: CST Number: PROFIERTY OWN, ER ~iUT- ,~O T3D~ SOIL DESCRIPTION REPORT Page 2 of Z PARCEL I.D. # Depth Dominant Color Mottles Texture Structure Consistence Ba,ndary Roots GPD/ft Boring # Horizon in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench ME: w: Ground Z _0 L ?5,5415 /VlF-r r-S IF (k elev. pv,d ft. - L L • Ft 'PA 4 /w Depth to -S - - - limiting factor Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: Boring # k}.ice:: ' • • ire\{ '~•ti boa Ground elev. ft. Depth to limiting factor Remarks: Boring # g" C}Ca n...n.. Ground elev. ft. Depth to limiting factor Remarks: D-8 o ~ e 7 .p N o ~ C ~ 0 O 11 O O ~ d h m R' Z ti I I~j r a qR, ~e w INTI r ti ~ n 0 ti ~ y Q a~ w 0 ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer afm i Mailing Address 5 s!~~- , Property Address aiLt-- (Verificati n required from Planning Department for new construction) City/State Parcel Identification Number 3 LEGAL DESCRIPTION , Property Location Sec. S T N-R S W Town of L)cx h 1,6 kS Subdivision , Lot # Certified Survey Map # Volume Page # 7cl 7!!~ Volume ` , Page # r Warranty Deed # , Spec house ❑ yes $-no Lot lines identifiable X-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, journeyman plumber, restrictedplumber 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. 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 day the three ye x lion SIGNAtURE OF APPLICANT DATE OWNER CERTIFICATION I (we) certify that all sta ments on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of th roperty desc ' bove, irtue of a warranty deed recorded in Register of Deeds Office. Q /X/ G IGN TUBE 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 i - VOL 1310 PUF O01 578111 , Document Number Q r / Document 75Ue finger E IST l -OFF1 . CE ST, CROIX CO.. WI Rso d for R600rd - APR 2 9 1998 4:30 P. M St.Croix county zoning office St. Croix County Government Center 1101 Carmichael Road Ra tar of Hudson, Wisconsin 54016-7710 Recording Area (715)386-4680 Name and Return Address fA Cp uJ~~ S AFFIDAVIT State of Wisconsin ) d Z d g~ ' 30 O ss. o ~ -l Die County of S tom. Croix ) Parcel Identification Number (PIN) 1AV& t ~!s ?o(~/e , being duly sworn states, under oath that: (name) 1. l~i /she is the owne /part owner of the following parcel of land orated in Croix County, Wisconsin r corded in Volume, Page, Document No.S .r O(9 St. Croix County Register of Deed's Office: A parcel of land located C , w 6 2. The above parcel has had added o it the following described parcel ec rded in volume (a-7 Page~Document No. & St. Croix County Register of Deed's office, resulting in a single parcel: T A parcel of land located ~e, St. Croix County, Wisconsin, de crib d s follows: Tbia ia(ocuution muct be complctod by cubmicrcc: docwncnt title nn,nc A return addrefr and PIN (f rcquircdf. Othrr _ir{/armation rush ar dre `rutting clarercr, legal deredption, ca. may be placed on thlr firm parr of d.c documcru or mar be placed on -idida-ol lager of nct doetanen{ rntr: Urc of dw eowrNre al:G onr lure ra ~o-, dnc-; t a.(~ 1 r.• r' . t /,-r {r':rn•ntin ,SLUwe'. 39.517. {l•pDA 76\S VOL D, PAGIOW 3. The addition is a transfer exempt from Chapter 18 of the St. Croix County Land Use Regulations pursuant to Section 18.05 (A) (3) . 4. The purpose of this affidavit is to notify the public of the addition and the resulting parcel. / &XY,71 Subscribed and sworn to before me this .2q~ day of _ 19 V ti.N ary Public, State of Wisconsin ~ PNyYcorfimission expires C : pU Ti\ instrument was drafted by f►/~ n S F Q STATE BAR OF W1SCi>NSI% F, 414'A9 - IQN: ` i WARRANTY DEED DOCUMENT NO. VOL 1274PAu5t15 BRENT D. ROBERTSON AND PATTI C ROBERTSON HUSBAND AND WIFE AS MARITAL PROPERTY WITH R?fAtT,_ TO SURVIVORSHIP ,meys and warrants to MYREN R COWLES AND KAREN .1 ' HUSBAND AND WIFE AS MARITAL PROPERTY WITH RrOM Iciri a NOV V TO SURVIVORSHIP 9;30 q i pc~ -o~} 7se•J•_ I' the following descnhed teal estate in ST CROIX CY• THIS SPACE RESERViD FOR RECORDING DATA - , A State of Wis:onsin_ NAME AND RETURN ADDRESS LOT 3 OF CERTIFIED SURVEY MAP DATED AUGUST 27, :996 MYREN COWLES ii DOCUMENT #548744, VOLUME 11, PAGE 3149 .+55 90TH ST SECTION 35, T29N, R18W HUDSON WI 54016 042-1098-50-200 Parcel Identification NamGer E TRANSFER This IS NOT EE homestead property. (is) (is not i ti s j Dated this 30TH day, of 0CTCBc~ A.D.. IQ 97 ,j - (SEAL) / J EAL - ' _ BR T. D ROBERTSON - 1! (SEAL) PATTI C ROBERTSON • - - AUTHENTICATION ACK%o1%I.EIX;%IE\T Signature(s) _ STATE OF WISCONSIN. CS. x ST CROIX County. Pem naliy :ame IvIore me this 30TH Ja, :unhrnti;ated this day of Id OCTOBER W 97 the aho,e ra^i:_' r ut,EtiT ^u R06ERTSOiJ AND PATTT C R OSrnT :.a ~R TriLE MEMBER STATE B\R OF %V!SCONSIti , If 11"I. n- inW') t. t.• he the p •ra,TE' S uho ccc; ot:J 'h: r{. authlmrcJ M y'lb.tb, \\'IS. Stan 1 mur.rr 4t,1,he same THIS INSTRUMENT WAS DRAFTED By PATTI C ROBERTSON _ _ A 1~_ SONx'_ Rhi,:. r_3T 'C"_OIX ma, h: Mithcnh r;J or r• t,. t e.k7, oltJj!cJ &,th arc n.4 "%i% Commi...,,-n Pcrmancnt 11 n. •t. .!at, ef• ra:.. ;r r Bearings are referenced to the O z north line of the NWk, assumed n r, to bear S89°33'12"W. o r o 3 (D > 7 (.n CL CD OD w w ~ r 00 • O • 8 ~ n ~_r FILES 121 0 _oX N M UNPUTI TEL, LANDS A U G 2 7 1996 N CO X West line of the NEB KATHLEEN H. WALSH It a ° 4of the NWk, of Section 35 nepisler of Deeds -n -a t. Croix o., 0) (D m o S00°27'26"W 394.93' CD 1< M -1 CD N m -~-n 361.93' ~ O W , ._0 O rr . c 33.00' t7 = N N (~D d O o. d n -1 rh 7C' N -h CD 6 ' r O (t O F F 'r7' N h N ~ WLn a m Oo r • . N' S O Oo a N O O ID o 7 -I NO N N N OD d N .a N w w Iz 0 n C fi 'o ly ~r r h M ~O 1 (D -1 I` a o ~ I im 3E :E a IZ w 0 0 T, 1-0 w w w r- Lt p - M, 11 N -I S00°27'32"W 394.93' E IM ly cn IR1 361.93' 33.00'- 1C IZ w C 10 IM ~L7 0 Ir' ~ olo W < M s ly 1Q w w jo -p ao Ln 'r ° ('0 Na~O N cnm cno~ CO CO ~ %b -0 N L N OD 00 ° W o 0 F -n x z -n7 F K) - ` Cr 7 rr n ct A _ - Ct z m y o _ z z I O E E $ tD O O 4- 361.88' 33.00- s ° CD Ln F, N00°15'17"W 394.88' z m O CD p 1i LOT N (p C.S.M. IN M V9, PG. 2573 w 00 i s .