HomeMy WebLinkAbout012-1025-80-000 (3)Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM
Safety and Building Division
INSPECTION REPORT
GENERAL INFORMATION (ATTACH TO PERMIT)
Personal information you provide may be used for secondary purposes [Privacy Law, s 15 04 (1)(m(l
Perri Holders Name City village Township
ELIZABETH M FALL TOWN OF ERIN PRAIRIE
CST BM Elev IInsp BM Eiev IBM Descriotion
TANK INFORMATION
TYPE
MANUFACTURER
I CAPACITY
Septic
\ e
00
Dosing
l9 S�
Aeration
p \
Holding
TANK SETBACK INFORL4ATlnw
TANK TO
PIL
WELL
BLDG.
vent to Air Intake
ROAD
Septic
Dosing
Aeration
Holding
PUMP/SIPHON INFORMATION V,ry g fp
Manufacturer
_C��JS GPM
Model Number a-
TDH Lift S3 Friction oss Syste Head TD Ft
Forcemain Len gt_hDia i Dia.�e l- to Well
avts. M00%dMr 1 IVN *T51 tM
ELEVATION DATA
STATION
BS
HI
FS
ELEV.
Benchmark
J
Alt SM
Bldg. Sewer
�� •43
$°i �i1
SUHt Inlet
St,
DI Inlet
Dt Bottom
6�33t
�S •�
Header/Man
Dist. Pipe
, �R
Bot. System
Final Grade
St
MT -Qt/
BEDfTRENCH
DIMENSIONS
Width �t
Lenplh /
�/1 LJ
No Of es
PIT DIMENSIONS
No Of Pas
Inside Die Liquid Depth
SETBACK
INFORMATION
niQTRIGt ITIAU
SYSTEM TO
PIL
BLDG
LL
JLAK&STREAM
LEACHING
CHAMBER OR
UNIT
Manufacturer
Type
if System
evereaa
t
n i
Model Number
Header! nifold
( tl f�y,
Distnbution
63
\\
1
y Hole Size
x Hole Spaonng Vent to Air Imaka
Length Diay
Leng%5)-3
Length
pia
S sari
P 9
�' O�
cull rnvco
- - � rressuro aysiems umy xx Mound Or At -Grade Systems Only
Dep�r 4K#x Depth Over x Depth of a Seeded'Sodded - Mulched
189djl2ch Center t� Bed(Trench Edges Topsail
✓ P _, Yes `_' No Yes No
COMMENTS: (Include code discrepencies, persons present, etc.} Inspection #1 Inspection #2:
Location: 1612 CTY RE) T r t 3t� Se�}t'C t gel `�`r t Va,-6A
1.) Alt BM Description = fi l,�frCoVe-'
2.) Bldgsewer length a= I B �d l� r j�a ,,tA a �✓ 'Ut 1M ^
- amount of cover = e71gC
Plan revision Required? Yes 'No I
Use other side for additional information. �_�� -� p b
SBD-6740 (R.3/97) data 3 pd.e. Signature - - - - Can No LV
:2-
s:. DEC 12 202
-_. St. Croix Count
1400 JE rt
ot
P.O. Bo
tin. M 537U7- 7,62
S.ilmy Pa Nmrber (to be iced in by co.)
64tg" 3
pplication L;u StmeTnaradio&%-*a
io tcoarrl-oe uith SPS 3$ 321a1 W� Ada Cody v dint of mi: lbrtdto ibe T
is � t
Po obtaining a mmitary perrk Alai APPhr�m forms fix stale-o�raed POari3 are sabtaitled b �-
The Dgmus at of SeW led Pt m A , ideal Services. Pesmi ie. .. )as pow ide may be med for Addr'm (j&M=w dm mftg address)
is accordmoe.rth the Ppirmy LOW L 15L)DYA& Sacs.
L Application lafermatioa — Plebe Print AH 18%nviioa
Proputy O%MWS Name Paroei f
D %
Mal" Adders Play.lAcedw
l61 a 7 - _
c.c Lot N A
city, state rip code Pltowe Number S G V, S C—V.. sec6cm r
New Sya I �s - a as - y yi (tom
T 3&N R17 Eo
TY" of BWMmg (check mill tilt apply) Lot d
or 2 finaft D.eYiig — Number cf Badtoa Stbdiv�io. Namr
❑ — Desrnbr ux Block 0
❑ SMe Owned- Dombe Use ❑ Cut' or
Ill. TM of Ptaatit:
A 10 New System
CSM Number ❑ Vtllayse of
.� fi] Tone of � 4
mime WX On >iat A. CAmipieft Noe B K )
rurttr = S) ❑ TI=WMM Tank Replaoaoert Dolt'•
❑ Odw MoNkedioo to S)sltm (crplain)
B,
11 P at
❑ Pemit Rcvisioe
[ of
Pamik Transfer to New
Lit P4� ion
Per ' Doe hsued
I
I
�❑
S � >P�
IV. T of POWTS S
Qm* all that
❑ Noe-Pticmur� b-Graeed
❑ Preurimed b4i0irowd
❑ AI-G a ® Motmd a 21 im of mitabie ❑blond < 24 im of suitable sal
❑ HOWM Tart ❑ Odu r Dispersal Cctapoom (erpiair) ❑ P
MMM
r t
Y.
Ara latoraatialt;
�
,
Design Flow (Wd)
DcsiW Sod ApPtic tim
Dispersid Met Regmrtd (sB
Dual An* Proposed (s4
5)atem Deratim
y� o
Rac(Wdtn L0
�5 o
ySv
95 :1 9 4 e �
YL Tank left
CWac in
jam
�,.
p_ 4
Gtdkms
TOWf
Gailoos
of
Uatts
c-
bdaon6
Ilea Tab
Tab
Septic or Holding Tam
po o
--
/oo a
DasmaChuaba
z <-^
r-f
I r--r I
r-i
I r
VIL Rapottslly SCaewent— L for , ig , aaaoe
Plnrrtber's AMMU (Sweet. City. &05, 7.4 Codc)
7y 3 P-6 14A X U4-
far btrstidlud n sloe POD "M *on safte tttaeied pan&
Kip-
U%s Mm ka Busitns Pb000 Number
_S7 7is 7hb o
[.4-e-Z: 5 y,6o
VIIL C Use Oak
Appovoa ❑ Z�t� Pewit FeeDime4 - Aagt -for Depitl s r7F Z
DL COMMO ( 3)�Cr s -ad �CB�-
. Sepik tank, effluent filter and dispersal cell ,
n'rtlst be Serviced I maintained as per 4} tM
management plan provided by plumber. kt;- -�—%
2:AISethackrequirementsft0be lid lIMAIrow asorcoaft-••tr �..t ara:11110AM
as per applicable code 1 ordinances. P.Q .ber rovt S n� ,�a'kc2
(%I) 5p ( 14-&1- rece� V-�V't
Z�fZ� oZ#
OPI
cr or
- -"
X.4 17
vo
3 w
CP LP
dt
Gj
CP
uo
I-q
owl
a aw PAW "Sam
l
2i or Fvr- 11-r fiat4 Ir-
.� N �- Asa Qt'
EMSTING TANK HAS
COLLAPSED.
3 BR
OF
Wisconsin I epartrn.xrt of Safely and Ptofewomal Scrviacs
Division of Industrs Services
4822 Madison Yards Way
PO nor 7302
Madison. WI 53707
November 17, 2022
CUST ID NO.: 224832
MARY JO HUPPERT
25720 FIREFLY LANE
WEBSTER, WI 54893
CONDITIONAL APPROVAL
PLAN APPROVAL EXPIRES: 11/17/2024
MUNICIPALITY:
TOWN OF ERIN PRAIRIE
ST. CROIX COUNTY
SITE:
ELIZABETH M. FALL
1612 C.T.W. T
NEW RICHMOND, WI 54017
SE 1/4 OF THE SE 1/4, SEC. 09, T30N, R17W
FOR:
Design Wastewater Flow Value: 450 GPD
Bedrooms: 3
Limiting Factor(s): 31"
Maintenance Required: Effluent Fitter
�r Phone:608-266-2112
7� Web: httn dsos.«i,
Email: dspsii ms,")trsin ro
Toov Evers, Governor
,n Dan Hereth, Secretary
Identification Numbers
Plan Review No.: PWTS-112202830-C
Application No.: DIS-112256155
Site ID No.: SIT-109697
Please refer to all identification numbers in each
correspondence with the Department.
condwon.uy
APPROVED
DEPT OF SAFETY AND PROFESSIONAL
SERVICES
DIVISION OF INDUSTRY SERVICES
r
SEE CORRESPONDENCE
Mound Component Manual - Version 2.1 (May 2022-
2027)
Pressure Distribution Component Manual - Version 2.1
(May 2022-2027)
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.
Reminders
• A sanitary permit must be obtained from the county where this project is located in accordance with the requirements
of Sec. 145.19, Wis. Stats.
• Prior to construction of the dispersal area, check the moisture content of the soil to a depth of 8 inches. Proper
soil moisture content can be determined by rolling a soil sample between the hands. If it rolls into a 114- inch wire, the
site is too wet to prepare. If it crumbles, site preparation can proceed. If the site is too wet to prepare, do not proceed
until It dries.
• 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(2xd), Wis. Stats.
• A state approved effluent filter is required. Maintenance information must be given to the owner of the tank explaining
that periodic cleaning of the fitter is required.
• A copv of the approved plans, specifications and this letter shall be on -site during construction and open to inspection
py autnonzea rel2resentatives or the uepanment. wnlcn may lncluae iQwi w5mouls.
Owner Responsibilities
• The current owner, and each subsequent owner, shall receive a copy of this letter. Owners shall also receive a copy
of the appropriate operation and maintenance manual(s) and be responsible for ensuring that POWTS is operated
and maintained in accordance with this chapter and the approved management plan under s. SPS 383.64(1).
• In the event this soil absorption system or any of its component parts malfunctions so as to create a health hazard,
the property owner must follow the contingency plan as described in the approved plans.
• The owner is responsible for submitting a maintenance verification report acceptable to the county for maintenance
tracking purposes. Reports shall be submitted at intervals appropriate for the component(s) utilized in the POWTS.
In granting this approval, the Division of Industry Services reserves the right to require changes or additions, should
conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall
relieve the designer of the responsibility for designing a safe building, structure, or component. The Division does not
take responsibility for the design or construction of the reviewed items.
Inquiries concerning this correspondence may be made to me at the contact information listed below, or at the address on
this letterhead.
Sincerely,
Fee Required: $250.00
Fee Received: $250.00
Gerard M Swim Balance Duc: $0.00
POWTS Plan Reviewer Refund Expected:
WI DSPS - Division of Industry Services $0.00
Phone: (608)789-7892
ierrv.swim _ wi.aov
MOUND AND PRESSURE DISTRIBUTION COMPONENT DESIGN
Residential Application
INDEX AND TITLE PAGE
Owners Name:
ELIZABETH M. FALL
1612 C.T.H. T
NEW Rr+WOND, WI. 54017
Lepal Description:
SEi/4 of the SE1/4 Sec. 09 T30N R17W
Township:
ERIN PRAIRIE
TANK HAS COLLAPSED
Camgr
St Croix
Subdivision Name:
NA
Number.
NA
Btvch Number:
CommonLot
APPROVED
DEFT. OF SAFETY AM ►ROFEssiowAL
Parflel I. D. Number:
012.1025 - 80 - 000
SEMMES
DIMS M of NousTRY sEMM"
Plan Transacdort No.:
���— -
.,..••,,..,,......
Pape 1
index and we
sEE coinlEsrowoE
.
Pape 2
Data W"
Pape 3
Wxond draOkW
.
1'
Pape 4
Lateral and dose tw*
`
k
Pape 5
Srslem nwhAwwwe spedNkmborm
_
Pape 6
Manspemw t and cwWngwi y
plan
Pape 7
Pump curve and speakOMM
Pop
pe
'',.
9
Sail test
L`.� • • . .. , ON
Pape 10
Soil iesl
��. ` �.�: i : • �' =
,•'///f//ij1U111i1111N1\I�",•
Pape 11
Sail test
Pape 12
As"
Desow.. Mary Jo Ruppert License Number: 1859 - 007
Dole: 1111 Number. 715 - 426 - 1775
Slpa,�: o l t
Designed Purswnt to #w Z . l (,yu 2-C L 2- - 2-0 2-7,
mound Cenvanwif kawww for POWTS Vr*ionA4 SM10801-P (N bf)61), aM both
SSWIMP PLMCI brt 9.6 Design of Pr OUM Dlsa&Am Nstwofa for ST-SAS (01161) and
p non DWrlb1WW Comp Mtt A WWW Var. 3&SBD-10708-P (N. 011M) (MA4 2.07-2.- Z0L7)
ZA
Version 7.0 (R. 0312012) Page 1 of 12
Mound and Pressure Distribution Component Design
Design Worksheet
(R or C)
Site Information
Residential or Commercial Design
Estimated Wastewater Flow (gpd)
Peaking Factor (e.g. 1.5 = 150%)
Design Flow (gpd)
Site Slope (%)
Contour Line Elevation (ft)
Depth to Limiting Factor (in)
In -situ Soil Application Rate (gpd*)
R
300.00
1.50
450.00
4.50
94.6T
31.00
0.40
Distribution Cell Information
75.00 Dispersal Cell Length Along Contour (ft) _
1.00 Dispersal Cell Design Loading Rate (gpdM2)
1 I Influent Wastewater Quality (1 or 2)
(C or E)
Pressure
Disribution Information
Center or End Manifold
Lateral Spacing (ft)
Number of Laterals
Orifice Diameter (in)
Estimated Orifice Spacing (ft) _
Forcemain Diameter (n)
Forcemain Length (ft)
Pump Tank Elevation (ft)
a
3.00
2
0.188
3.75
2.00
100.00
85.00
325
System Head (ft) x 1.3
9.76
Vertical Lift (ft)
1.51
Friction Loss (ft)
0.00
In -line Filter Loss (ft)
14.52
Total Dynamic Head (ft)
Lateral
Diameter Selection
in. dia.
options
choice
0.75
1.00
1.25
1.50
x
x
2.00
x
3.00
x
Treatment Tank Information
1000.001 Septic Tank Capacity (gal)
Wieser IManufacturer
Note Sand fin (0) calculations assume a
Tabie 38344-3 in -situ soil treatment for
fecal ccliform of- 36 inches.
6.00 Cell Width (ft)
Are the laterals the highest int
in the distribution Y
network? Enter Y or N
If N above, enter the elevation ft
of the highest point.
11.25 ftz/orifice
Does the forcemain drain back? I Y
Enter Y or N
16.31
Forcemain Drainback (gal)
67.47
5x Void Volume (gal)
83.78
Minimum Dose Volume (gal)
26.21
System Demand (gpm)
J
Manifold
Diameter Selection
in. dia.
options
choice
1.25
x
1.50
x
x
2.00
3.00
Gallonslinch Calculator (optional)
Total Tank Capacity (gal)
Total Working Liquid Depth (in)
gal/in (enter result in cell B49)
Dose Tank Information Effluent Fitter Information
650,001 Dose Tank Capacity (gao PolyLok Filter Manufacturer
17.001 Dose Tank Volume (gallin) 525 Fitter Model Number
Weiser Manufacturer
Project: ELIZABETH M. FALL
Page 2 of 12
Mound Plan and Cross Section Views
..................................................
1
� ...::.....' ::..:....:...... Obeenratwn Pipe
•�
K : •.. •.. •..... % ti..,. ti..,..,:.,:,:.,:.,:.,: •.:.,:.•:.,:.. • • :.
::':: :}:7r•; 'r;: �.
: .: .: .: .:: r.r r. r.
L•S•S•S• S.S.S�ti�S•S•S•S•S•S '. '. .• .•
'•'r�::.,��'yy • .• .• .• r•r•r•r•r•r• r•r•r.r•r•r•r.r.r.r . •
'•?1�:;-':•':•:-:Y'••r'::'�'•'" 5:'•�•�•�'ti'•'}rir:r}r}rirSr:ri:i::::•::
•tii:::�;. •r;. r; r; r.:
•:.r
B
:-
L
Mound Component Dimensions
Down slope toe extension made.
A 6.00 ft E 9.24 in H 1.00 ft K 7,28 ft
B 75.00 ft F 9.50 in i 9.00 It L 89.56 ft
D 6.00 in G 0.50 ft J 4.74 ft W 19.74 ft
450.00 (ft�) Dispersal Cell Area 1 1125.00 (ft?) Basal Area Available
6.00 (gpdtlt) Linear Loading Rate 1 7.50 (ft) 1/10 B Obs. Pipe Placement
Mound Cross Section View
Aggregate Dispersal Area
Finished Grade 96.96 (ft)
IF95.17 (ft) �
Dispersal Cell }
Elevation
• - • __- -rrr rti-TST
m
H
,rrrrrrrrrrrrrrr,. G
•rrrrrr ,rr,,,,rrrr,.
Iersel cell 95.67 (ft) Lateral
Invert
D
4.5 % Site Slope
Shading Key
I g
T
10
_ Topsoil Gap
a
1.5 ft
❑2
Subsoil Cap
M
®
=
ASTM C33 Sand
Tilled Layer
Aggregate
0.5 ft
94.67 (ft) Contour Elevation
Geotextile Fabric Cover
See lateral details on
Page 4 for number, size,
and spacing of laterals.
Laterals are equally
spaced from the
distribution cell's
centerline in the
distribution cell (AxB).
Proiect: ELIZABETH M. FALL Page 3 of 12
x« cerxer ava tM
P
End Connection Lateral Layout Diagram
•- Turn -up wfballva"oroloanoutplug
All Werals are identical I`- X� Holts drilled on the bottom of the latwal
equ+llll spaced
Faoe main oonnection via tee of cross to mar4old at VA point.
Laterals Morcemain Sch 40 PVC per SPS Table 384.30-6
Number of Laterals
Lateral Diameter
Lateral Length (P)
Lateral Spacing (S)
Lateral Flow Rate
System Flow Rate
Total Dynamic Head
2
1.50 in
73.53 ft
3.00 ft
13.11 gpm
26.21 gpm
14.52 ft
Orifice Diameter
Orifice Spacing (X)
Orifices per Lateral
Orifice Density
Manifold Length
Manifold Diameter
Forcemain Velocity
Dose Tank Information
Electrical as per NEC 300 and _r
SPS 316.300 WAC
Disconnect
Tank component is properly vented
Weiser
Capacityl
650.00
Volume
1 17.00
Manufacturer
Gallons
galllnch
Dimension
Inches
Gallons
A
20.41
346.92
B
2.00
34.00
C
4.93
83.78
D
10.90
185.30
Total
38.241
650.00
Alarm Manuaaacturer JS.JE Rhombus
Alarm Model Number ITank Alert AB
Pump Manufacturer IGOULD
Pump Model Number I PE 41
A
B
C
_t
tank.
Pump Must Deliver I 26.21 gpm at 14.52 ft TDH
s
0.188 in
3.87 ft
20
11.25 ft`/orifice
[3.00 ft
1.50 in
2.68 ft/sec
Locking cover with warning
label and bcking device and
sealed watertight
4 in min_
1
1( Altemale outlet
location
Forcemain diameter
__1 2 in.
Weep hole or anti -
siphon device
Pump off elevation (ft)
85.91
Dose tank elevation ft
85.00
Note: Switches
containing mercury
may not be used in
this system.
Project: ELIZABETH M. FALL Page 4 of 12
Mound System Maintenance and Operation Specifications
Service Provider's Name POWERS SEPTIC SERVICE Phone P715-386-4680
15-246-5738
POWTS Regulator's Name St. Croix Coun Zoni Phone
System Flow and Load Parameters
Design Flow - Peak 450 gpd Maximum Influent Particle Size 1 /8 in
Estimated Flow - Average 300 gpd Maximum BOD5 220 mg/L
Septic Tank Capacity 1000 gal Maximum TSS 150 mg/L
Soil Absorption Component Size 450 ft` Maximum FOG 30 rng/L
Type of Wastewater Domestic Maximum Fecal Coliform >10E4 cfu/100 mL
Septic and Pump Tank
Effluent Filter
Pump and Controls
Alarm
Pressure System
Mound
Other
Service Frequency
Inspect and/or service once every 3 years
Should inspect and clean at least once every 3 years
Test once every 3 years
Should test monthly
Laterals should be flushed and pressure tested every 1.5 years
inspect for ponding and seepage once every 3 ears
Miscellaneous Construction and Materials Standards
1. Observation pipes are slotted and materials conform to Table SPS 384.30-1, have a watertight cap.
and are secured in as shown in the mound component manual.
2. Dispersal cell aggregate conforms to SPS 384.30 (6)(1), Wis. Adm. Code.
3_ All gravity and pressure piping materials conform to the requirements in SPS 384, Wis. Adm. Code_
4. Tillage of the basal area is accomplished with a mold board or chisel plow.
5. The mound structure and other disturbed areas will be seeded and mulched to prevent soil erosion
and help reduce frost penetration.
Lateral Turn -up Detail
Finished •...........�• •�������������•
Grade
6-8" Diameter Lawn Threaded Cleanout
Sprinkler Valve Box Plug or Ball Valve
Distribution
Long Sweep 90 or Two
45 Degree Bends Same
Diameter as Lateral
Project: ELIZABETH M. FALL Page 5 of 12
Wastewater
METERS FEET
40
PE51
35
10 2 GPM
30 PEa1 1 FT
= 25
u
2
Z 20
0
1 10
5
MODELS: PE31. PE41, PE51
HP: .33..40, .50
0 L 0 0 10 20 30 40 150 60 70 GPM 80
U 5 10 J 15 m-'/h
CAPACITY
PERFORMANCE RATINGS
PE31
Total Need GPM
(het of water)
5 52
10 42
15 I9
20 16
25 0
PE41
Total Neil GPM
(feet of water)
r R 161
10 51
15 46
20 33
75 16
PEST
Tool Head GPM
(feat of water)
10 67
20 50
25 39
30 26
35 7e
� ULAZ 7J F 04 -L
d
ur
rq
z
U
r
db
r_
1 o
w
4 pump j flcrw
EXISTING TANK HAS
COLLAPSED.
1
Mound System Management Plan
Pursuant to SPS 383.54, Wis. Adm. code
This system shall be operated in accordance with SPS 382-84 Wis.Ad`m. Code, and shall maintained in accordance with iW component
manuals [SBD-10691-P (N.01101), SSWMP Publication 9.6 (01/81), and Pressure Distribution Component Manual Ver. 2.0 SBD-10706-P (N.
01101)] and local or state rules pertaining to system maintenance and maintenance reporting
No one should ever enter a septic or pump tank since dangerous gases may be present that could cause death.
Septic and pump tank abandonment shall be in accordance with SPS 383.33, Ws. Adm. Code when the tanks are no longer used as
POWTS components
Septic or pump tank manhole risers, access risers and covers should be inspected for crater tightness and soundness. Access openings
used for service and assessment shall be sealed watertight upon the completion of service. Arry opening deemed unsound, detective. or
subject to failure must be replaced. Exposed access openings greater than 84nches in diameter shall be secured by an effective locking
device to prevent accidental or unauthorized entry into a tar* or component.
Soodc Tank
The septic tank shall be maintained by an individual certified to service septic tanks under s. 281 48, Stats. The contents of the septic
tank shall be disposed of In accordance with Nit 113, Win. Adm Code. The operating condition of the septic tank and outlet fitter shag be
assessed at least once every 3 years by irlSpeCtion.
The outlet filter shall be cleaned as necessary to ensure proper operation. The filter cartridge should not be removed unless provisions
are made to retain solids in the tank that may slough off the filter when removed from its enclosure. If the filter is equipped with an alarm, the
filter shall be serviced if the alarm is activated continuously. Intermittent filter alarms may indicate surge flows or an impending continuous
alarm.
The septic tank shall have its contents removed when the volume of sludge and scum in the tank exceeds 1/3 the liquid volume of the
tank. If the contents of the tank are not removed at the time of a triennial assessment, maintenance personnel shall advise the owner of
when the next service needs to be performed to maintain less than maximum scum and sludge accumulation in the tank.
The addition of biological or chemical additives to enhance septic tank performance is generally not required. However, if such products
are used they shall be approved for septic tank use by the Department of Commerce.
Pump Tank
The pump (dosing) tank shall be inspected at ►east once every 3 years. All switches, alarms, and pumps shall be tested to verity proper
operation. If an effluent fitter is installed within the tank it shall be inspected and serviced as necessary.
(Mound and Pressure Distribution System
No trees or shrubs should be planted on the mound. Plantings may be made around the mound's perimeter, and the mound shall be
seeded and mulched as necessary to prevent erosion and to provide some protection from frost penetration. Traffic (other than for
vegetative maintenance) on the mound is not recommended since soil compaction may hinder aeration of the infiltrative surface within the
mound and snow compaction In the winter will promote frost penetration. Cold weather installations (October -February) dictate that the
mound be heavily mulched as protection from freezing.
Influent quality Into the mound system may not exceed 220 mg/L BOD,, 150 mg/L TSS, and 30 mg1L FOG for septic tank effluent or 30
mg/L BOD5, 30 mg/L TSS, 10 mg/L FOG, and 104 cfu/100 m L for highly treated effluent- Influent flow may not exceed maximum design flow
specified in the permit for this insta Nation.
The pressure distribution system is provided with a flushing point at the end of each lateral, and it is recomfinended that each lateral be
flushed of accumulated solids at least once every 18 months. When a pressure test is performed it should be compared to the initial test
when the system was installed to determine if orifice clogging has occurred and if orifice cleaning is required to maintain equal distribution
within the dispersal cell.
Observation pipes within the dispersal cell shall be checked for effluent ponding. Ponding levels shall be reported to the owner, and any
levels above 6 inches considered as an impending hydraulic failure requiring additional, more frequent monitoring.
GontinWricy Plan
If the septic tank or any of its components become defective the tank or component shall be repaired or replaced to keep the system in
proper operating condition.
If the dosing tank, pump, pump certrols, alarm or related wiring becomes detective the defective components) shall be immediately
repaired or replaced with a component of the same or equal performance.
If the mound component fails to accept wastewater or begins to discharge wastewater to the ground surface, R will be repaired or
replaced in its' present location by increasing basal area if toe leakage occurs or by removing biologically clogged absorption and dispersal
media, and related piping, and replacing said components as deemed necessary to bring the system into proper operating condition
See Page 5 of this plan for" name and telephone number of your local POWTS regulator and service provider
Preft2mbnant Units
The inlbmmation and schedule of mananagement and maintenance for pretreatment devices such as aerobic treatment units or disinfection
units are attached as separate documents and are considered part of the overall management plan for this system
Project: Page 6 of 12
1111i-1C� ((y �S
1 of
Wscons+n gepanment of Sat" & Proksyonal Se+v
` Osv,S,On9t InduS►ry $tryK&s
SOIL EVAt_ A ION REPORT
In accoroance with SP "s Ad- Code
J 1q C,
All-1, c- ele sir Dl- on Gaper no-. Wu ow 0 1 Q = 11 rrrlrs on We Pan PvAA 'nc Jde
p^111
- _ - _
Pam* I D
bx not noted to wert.Ca1 and Wzonta elvelce point IBMI dvatbeon and WceM SOW-
%{z'31
sca a or dnhens<w* lowlh &-ow a-►d bdabon and deUW.e 10 nea"M road
Dow
Pbaaa ppw all .
Rew4w" tor
I
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Pmppty LocabM
rf T r N R _I
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G&A lot , L Y' J Y. S
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Q RapiBpr .W ❑ Pubat or oym meow - once*F,OOd Plan eevabon f apGtcaDe
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9or� • � Ground SL Af•rs ee. 2L211
Saw Aopr ;Kw Rate
Camas = 90 ofty Raft L,- G�POOFf' —
Depth IG IN—" bcw = M r stow R
Sao Apprtab M Rats
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E1Aprera tit a Spp a 30 s ?Io AI L and TSS > 30 s 130 mIWL
Mam t 02 000 130 m L am TSS s 30 nuptL
SSd-8330 (R03/221
?4" Y -4 /Z
Page � of �1
�^�9 ❑ P T Gfaurd curt" ewv y i• A DOc-n to I bnq faCtty y_�7 / @*V R
So APP C& an Rate
t10f1tOn�Deplh I OW M M COW I PAdo. Dowfgbm Te.tufa SMWJM Cons sfexe 9ar+a+ry Rx'' - GP()Fr in MU1seh Ou At Gout cow Gt se Sh -EMI � -Eff@2
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l I Sail AOP'rudon pale
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In M4~ Q+ 11t Ccx+l Co1or W St Sh 'E�1 'Eett2
• EeMent e1 - 9M > 30 s I?0 rWt and tSS , 30 s 150 myt ' EROWK Q - RDD s 30-WL erd TSS s 30-WL
tea:: Ito c% I
c�
c T
R G
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I`
ST. CR NTY SANITARY SYSTEM File #:
i�o{{ice use only
OWNERSHIP/ADDRESS FORM cm-wzawl
Community Development Department will utilize this information to provide the property owner with
information regarding operation and maintenance of your new or replacement sanitary system! This
information will be provided as part of our ongoing efforts to protect public health, your well, groundwater,
surface water, property values, and county resources. Once approved, this completed form and educational
information will be sent to you by email. If you would like to view your issued sanitary permit online, you can
do so by using the Pro gin Files Scanned weblink.
OWNER/BUYER INFORMATION
Owner/Buyer
/ 7-A - ✓�
Mailing Addre,
City/State/Zip
Phone Number (required) 7
Email Address (requ
Parcel Identification Number ia? d 6 s�
(found on the property tax bill)
NEW SYSTEM: LEGAL DESCRIPTION
Property Location ,�LC-'/4 ,5 � 1/4 , SeO T30 N RI�W, Town of / �N '
Subdivision Plat I Lot #
Certified Surrey Map # , Volume . Page #
Warranty Deed # I / !/ R _*3 '?, (before 2006)Volume . Page #
Number of bedrooms 3 Spec house O yes f'no Lot lines identifiable OLyes O no
New Property Address
�Vk�
(Stad initials)
�� aWle —
i
(Verificat' n of new address
1 /9 zz
(Da e)
OFFICE USE ONLY
from Community Development Department for new construction.)
This form must be submitted with all Private Onsite Water Treatment System (POWTS) applications.
New System: include with this form 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.
Community Development Department - Land Use Division
715-386-4680 St Croix County Government Center 715-245-4250 Fax
cdd@sccwi.gov 1101 Carmichael Road, Hudson, Wl 54016 WWW.Sccw4QOV
-A
IServices Page
�� , ,•:tA' 'L_ SeNiOes
OIL EVALUATION REPORT
`���t In ante with SPS 385. We. Adm. Code County 1
Attach to silo on paps► x m x 11 inches in size. Plan must include. but
C 0
but not limited to and nce point (BM), direction and percent s 1. Parcel I.D.
scale or dimensions, location and distance to nearest r d
Please print all lnionnatlon. w V R iewed by I Datgq�
Personal information provide may be used for Purposes (Pmracy /
1�ff—,L
Owner LC o rJ +.00+ : Property Location ❑ 9
-1 o,�LTV, )k Va- II $tort Govt Lot ,SE Y. 5E Y. S 9 T 3D N R 11 E (or)C
I �r+perty Owner s Mailing Address Site Address or CSM and lot
City, State, Zip W; S y b 1,7 Phone Number ❑ City ❑ village ® Town Nearest Road
2_.
Cl WMCo(>atrtrction Use: Reeidential/Nlumberofbedrooms _ �_ Code derived dimignflowmte %SD GPD
JR Replacement ❑ Public or commercial - Deambe: Flood Plan elevation if applicable it. /
Parent material 1daSt sae..* t'• a V*75"rSko-14%) `Mevr-A St.
,-+ •e� 95' 17
General comments and 94. Ll'
IBoring ® Boring
[]Pit
i
f
Ground sine elevjY. On.
Depth to limiting f W3.2-in. / elev. It,
Soil Application Rate
MMW�
a
�MMM
rr
ttom�
Fal Bating f
[]Boring i
[]Pit Ground surface eiev.A62R-
Depth to limiting factor 3 ain. / elev. R-
Soil Application Rate
ors
. •
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_
r��■���
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r •
®ram
.
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_
• Effluent #1 = BOD > 30 s 22D mg/L and TSS > 30 s 150 mg/L " Effluent 02 = BOD, s 30 mg/L and TSS s 30 mg/L
SBD-8330 (R03/22)
❑Boring
Ong e ❑ Pit
Page a of
Ground surface elev. `13.33 ft. Depth to limiting factor—�J_in. / elev. ft.
Soil Application Rate
Horizon
Depth
In.
Dominant Color
Munsell
Redox Description
Qu. Az. Cont Color
Texture
Structure
Gr. Sz. Sh.
Consistence
Boundary
Roots
GPD/Ft2
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❑ Boring
❑ Pit Ground surface elev. ft. Depth to limiting factor In.1 ewv. ft.
Soil Application Rate
Horizon
Depth
In.
Dominant Color
Munsell
Redox Description
Qu. Az. Cont Color
Texture
Structure
Gr. Sz. Sh.
Consistence
Boundary
Roots
GPD/Ft2
'Eff#1
'Effk2
F-1
Boring 0
❑ Ong
❑ Pit Ground surface elev. ft.
Depth to limiting factor in. / elev. ft.
Soil Application Rate
Horizon
Depth
In.
Dominant Color
Munsell
Redox Description
Qu. Az. Cant Color
Texture
Structure
Gr. Sz. Sh.
Consistence
Boundary
Roots
GPDVFt2
`E111f1
'Effa2
Effluent #1 = BOO > 30 s 220 mg/L and TSS > 30 s 150 mg/L ' Effluent a2 = BOO, S 30 mg/L and TSS s 30 mg/L
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Parcel #: 012-1025-80-000 02/0112006 04:06 PM
PAGE 1 OF 1
Alt. Parcel #: 09.30.17,140 012 - TOWN OF ERIN PRAIRIE
Current X ST. CROIX COUNTY, WISCONSIN
Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type
00 0
Tax Address:
Owner(s): 0 = Current Owner, C = Current Co -Owner
% WILHELM BORGSTROM
ELEANORE M BORGSTROM
O - BORGSTROM, ELEANORE M
5310 W 13TTH ST
SAVAGE MN 55378
Districts: SC = School SP = Special
Property Address(es): ' ■ Primary
Type Dist # Description
• 1612 CTY RD T
SC 3962 NEW RICHMOND
SP 8020 UPPER WILLOW REHAB DIST
SP 1700 WITC
Legal Description: Acres: 40.000
Plat: N/A -NOT AVAILABLE
SEC 09 T30N R17W SE SE
Block/Condo Bldg:
Tract(*): (Sec-Twn-Rng 401/4 160114)
09-30N-17W
Notes:
Parcel History:
Date Doc # VoUPage Type
07/23/1997 886/141
07/23/1997 5321584
b.
7iV]5 SI immARY Bill #: Fair
Market Value: Assessed with:
104732
Use Value Assessment
Valuations:
Last Changed: 1110712005
Description
Class
Acres
Land
Improve
Total State Reason
RESIDENTIAL
G1
3.000
45,000
127.000
172,000 NO
AGRICULTURAL
G4
35.000
5,700
0
5,700 NO
UNDEVELOPED
G5
2.000
200
0
200 NO
Totals for 2005:
General Property
40.000
50,900
127,000
177,900
Woodland
0.000
0
0
Totals for 2004:
General Property
40.000
13,100
85,700
98.800
Woodland
0.000
0
0
Lottery Credit:
Claim Count:
1
Certification Date:
Batch #: 130
Specials:
User Special Code
Category
Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
QFPARTMENT OF INntISTFTy,
�NR PORT FSAFETY A BUILDINGOR
LABOR d HUMAN RELATIONS DIVISION
P.O. BOX 7969 ,,,ON -SITE SEWAGE SYSTEMS OFFICE OF DIVISION CODES d APPLICATION
M�A1DISON. WII+A5370T $Iglg Plan I D Number
SEk,SEk,S9,T30N-R17W IMIONVENTI El ALTERATIVE Illg °neat
Town of Erin Prairie ❑ Holding Tank ❑ In -Ground Pressure ❑ Mound
P L RADDRESS OF PERM411T L R
INSPECTION A -
Marvin Kirschbatm Route 3 ',qe wRichmand , WI 54017 7 - a 1— 9
MP/MPRSW No County - - Sanilary PermH Numbs,
Calvin Powers Jr. 1563 St Croix 119510
SEPTIC TANK/HOLDING TANK-
MANUFACTURER-
��rrl
LIQUID CAPACITY: TANK INLET ELEV' TANK OUTLET ELEV WARNING LABEL
PROVIDED
LOCKING COVER
PROVIDED
1
1�7J
BEDDING VENT DIA
YES
VENT MATL - HIGH WATER NUMBER OF ROAD PROPERTY WELL
NO YES 71 N
AUILDING VENT TO FRESH
❑YES ❑ NO
C ALARM FEET FROM c LI"
❑ YES ❑ 7 6 ��
AIR IN
NO NEAREST !� / L/
MANUFACTURER ••• REDD]NG
LIOUIO CAPACITY
PUMP MODEL- PVN43 PHDN MANU ACTUREn
WARNING LABEL
PROVIDED
LOCKING COVER
PROVIDED
YES ❑ NO
�/
7fJ /V/`
ES ❑ NO
E YES NO
GALLONS PER CYCLE"
(DIFFERENCE BETWEEN
PUMP AND CONTROLS OPERATIONAL
NUMBER OF
PROPERTY
WELL
VENT TO RESH
PUMP ON AND OFF L
ES ❑ NO
FEET FROM
L!
$0
r
JBUILDING
AIR I ET
801E ABSORPTION 9Y8Tf M. Check he loll moisture at the depth of plowing
FORCE
NEAREST
LE NGrH
DIAM7,T�ERMAMAJAk
J
AND MARKING
of excavation. (If soil can be rolled Into a wire. conslructlon shall cease until
the soli Is dry enough to continue.)
MAIN
CONVENTIONAL SYSTFIM-
BEDTTRENCN
MOTH
LENGTH:
NO OF
DISTR PIPE SPACING'
COVER
INSIDE 04A
M PITS
LIQUID
DIMENSIOl
TRENCHES'
MATERIAL PIT
DEPTH
GRAVEL DEPTH
BELOW PIPES:
FILL DEPTH
ABOVE COVER'
DISTR. PIPE
ELEV INLET.
DISTR PIPE DISTR PIPE MATERIAL
ELEV END
NO DIStA
NUMBER OF
BUILDIN&I.
H
I
PIPES-
FEET FROM
LINE,
AIR INLET
u�i urn wvw�rru_
NEAREST —�
Mound site plowed perpendicular to
slope and furrows thrown unslope:
Check the texture of the fill material for
PROVIDE A DIAGRAM OF SYSTEM
mound systems to make certain that it
ON REVERSE SIDE. SHOW
YES ❑ NO
meets the criteria for medium sand.
ELEVATIONS MEASURED.
SOIL COVER j TEXTURE:
PERMANENT MARKERS
OBSERVATION WELLS.
YES
❑ NO
YES ❑ NO
DEPTH OVER TREN(WBED
CENTER. /. �
DEPTH OVER TRENCHIBED
EDGES:
DEPTHS OF TOPSOIL.
SODOED
SEEDEO
MULCHED
f
/
e'
❑YES NO
ES ❑ NO
REES ❑ NO
PRESSURIZED DISTRIBUTION
SYSTEM:
BEDTTRENCH
WIDTH /
Err
LENGTH:
(� ?
Np pF
THE
LATERAL SPACING
GRAVEL DEPTH BELOW PIPE
/ 1 A
FILt. DEPTH ABOVE COVER
DIMENSIONS
j� f
�HE5
V
T t
�-
MANIFOLD
ELEV
PUMP
ELEV
MANIFOLD
DIA
ELEV
STRSTR
PIPE
DISTRIBUTION PIPE MATERIAL i MARKINGELEVATION
AND
DISTRIBUTION
IDISTFPIPF
IIIANII:I)LIIIIATFIIIALIW--T---7&O
PIPE'
DIA �
r� J
tNFORMAnON
SIZE
E SPACING
. Y
GRILLED CORRECTLY
COVER MATERIAL
VERTICAL LIFT CORRESPONDS O
APPROVED PLANS
YES ❑ NO
25YES ❑ NO
COMMENTS:
PERMANENT MARKERS
OBSERVATION WELLS NUMBER
DF PROPERTY
WELL
BUILDING
YES ❑ NO
FEET
& YES U NO NEAREST►
FgOM LINE
I Sketch System on
Reverse Side.
SBO-6710 (Ft. 06/88)
Retain In county file for audit
�_ 17TLE
7-o1 i Adninistrator
�DILHR SANITARY PERMIT APPLICATION COUNTY
�.� In accord with ILHR 83.05, Wis. Adm. Code
STATE SANITARY PERMIT 0
-Attach complete plans (to the county copy only) for the system, on paper not less than rt�:iI J 19 / D
8t% x 11 Inches in size. LJ Check If revision to previous application
-See reverse side for instructions for completing this application. STATE PLAN I.D. NUMBER
1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. g F -D go
PRC?POPTY OWNER PROPERTY LOCATION
MAAW e4191J"�kA,, S' ' Y. '/., S , N, R or W
AE)PERTY OWNER'S AILING ADDRESS LOT M BLOCK
, STATEj I ZIP CNN I PHONE NUMBER 1 SUBDIVIS�PN NAME OR CSM NUMBER
R. TYPE OF BUILDING: (Check one) I NEARfasT AD
❑ State Owned . VILLAGE
❑ Public 1 or 2 Fam. Dwelling of bedrooms I)
III. BUILDING USE: (it building type is public, check all that apply)
1 ❑ Apt/Condo
2 ❑ Assembly Hall 6 ❑ Medical Facility/Nursing Home 10 ❑ Outdoor Recreational Facility
3 ❑ Campground 7 ❑ Merchandise: Sales/Repairs 11 ❑ RestauranVBar/Dining
4 ❑ Church/School 8 ❑ Mobile Home Park 12 j Service Station/C We
5 ❑ Hotel/Motel 9 ❑ Office/Factory 13 Other: Specify --
IV. TYPE OF PERMIT: (Check only one in line A. Check line Bit applicable)
A) 1. ❑ New 2. X Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5. ❑ Repair of an
System System Tank Only Existing System Existing System
g) ❑ m Sanitary Permit was previously issued. Permit # — Date Issued
V. TYPE OF SYSTEM: (Check only one)
Non -Pressurized Distribution Pressurized Distribution Experimental
11 ❑ Seepage Bed 21 F7 Mound 34 ElSpeclfy Type
12 ❑ Seepage Trench 22 In -Ground
13 ❑ Seepage Plt Pressure
14 ❑ System-In-Flll
Other
41 ❑ Holding Tank
42 ❑ Pit Privy
43 ❑ Vault Privy
VI. ABSORPTION SYSTEM INFORMATION:
1. GALLONS PER DAY
ABSORP. AREA 3. ABSORP. AREA 4. LOADING RATE
5. PERC. RATE
(Min./inch)
6. SYSTEM ELEV.
7. FINAL GRADE
ELEVATION
12.
REQUIRED {aq. it.) PROPOSED (sq. ft.) (Gala/daytaq. ft.)
r�
Feet
I eet
Vol. TANK
CAPACITY
in allons
Total
of
Manufacturer's Name
Prefab
Site
Con-
Steel
glass
Plastic
Appr'
Near
Istln
INFORMATION
Gsllana
Tanks
oncret
strutted
Tanks
Tanks
Lift Pump TanklSl hon Chamber
Vlll. RESPONSIBILITY STATEMENT
I, the undersigned, assume responsibility for Installation of the onsits sewage system shown on the attached plans.
Plumt>•r'a flame (Pr f Pluv�er's Slynatu o �er/t►pe) MP/MPRSW No.: Business Phone N� bar l '
IX. COLWNIDEPARTMENT USE ONLY I In A ant SI nature (f
ptaapproved tary Permit es (Includes Groundwater Date tau g 9 f7
Surrharpe Fee)
Approved Owner Given Initial � � jy.,
Adverst Do
X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL:
SBD-WW (formerly Plb-67) (R. 11/88) DISTRIBUTION: Original to County, One Copy To: Safety d Buildings Division, Owner, Plumber
INSTRUCTIONS
1, A sanitary permit is valid for two (2) years.
2. Your sanitary permit may be renewed before the expiration date, and at the time of renewal any new
criteria in the Wisconsin Administrative Code will be applicable.
3. All revisions to this permit must be approved by the permit issuing authority.
4. Changes in ownership or plumber requires a Sanitary Permit Transfer/Renewal Form (SBD 6399) to be
submitted to the county prior to installation.
5. Onsite sewage systems must be properly maintained. The septic tank(s) must be pumped by a licensed
pumper whenever necessary, usually every 2 to 3 years.
6. If you have questions concerning your onsite sewage system, contact your local code administrator or the
State of Wisconsin, Safety d Buildings Division, 608-266-3815.
To be complete and accurate this sanitary permit application must include
I. Property owner's name and mailing address. Provide the legal description and parcel tax numbers) of
where the system is to be installed.
II Type of building being served. Check only one and complete # of bedrooms if 1 or 2 Family Dwelling.
Ill. Building use. If building type is Public, check all appropriate boxes that apply.
IV. Type of permit. Check only one in line A. Complete line B it permit is for tank replacement, reconnection, or
repair.
V. Type of system. Check appropriate box depending on system type.
VI. Absorption system information. Provide all information requested in #1-7.
VII. Tank information. Fill in the capacity of every new and/or existing tank, list the total gallons, number of
tanks and manufacturer's name. Indicate prefab or site constructed and tank material. Complete for all
septic, pump/siphon and holding tanks for this system. Check experimental approval only if tanks received
experimental product approval from DILHR.
Vlll. Responsibility statement. Installing plumber is to fili in name, license number with appropriate prefix (e.g.
MP, etc.), address and phone number. Plumber must sign application form.
IX. County/Department Use Only.
X. County/Department Use Only.
Complete plans and specifications not smaller than 8'% x 11 inches must be submitted to the county, The
plans must include the following. A) plot plan, drawn to scale or with complete dimensions, location of
holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water mains/water service;
streams and lakes; pump or siphon tanks; distribution boxes; soil absorption systems; replacement system
areas; and the location of the building served; B) horizontal and vertical elevation reference points;
C) complete specifications for pumps and controls; dose volume; elevation differences; friction loss; pump
performance curve; pump model and pump manufacturer; D) cross section of the soil absorption system if
required by the county; E) soil test data on a 115 form, and F) all sizing information.
GROUNDWATER SURCHARGE
1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of
regulated practices which can effect groundwater.
The monies collected through these surcharges are used for monitoring groundwater, ground-
water contamination investigations and establishment of standards.
SBD-&IN (R.tt/lib)
%'« 13 7 T
APPLICATION FOR SANITARY PERMIT
9TC.- 100
This application form Is to be completed in full and slgned by the owner(s) of
the property being developed. Any Inadequacies will only result In delays of
the permit Issuance. Should this development be intended for resale by
owner/contractor,(spee house), then a second form should be retained and
completed when the property is sold and submitted to this office with the
appropriate deed recording.
----------------------------------- - ---------- -------------------------------
Owner of property &-,/1 1T.r'�i�„�iS'�.�,
Location of property �,�_1/4 �_1/4, Section _, T�L_N-R ZW
Township
Address of site UA-0! _IS J,0S*-1!7_
Subdivision
Lot number
Previous owner of property
Total size of parcel __ / ?
Date parcel was created
Are all corners and lot lines Identifiable? _Yes No
Is this property being developed for resale (spec house)? Yes _No
Volume -Sa hand Page Number as recorded with the Register of Deeds.
INCLUDE WITH THIS APPLICATION THB FOLLOWING:
A WARRANTY DEED which Includes a DOCUMENT NUMBER, VOLUME AND PAGE NUMBER, and
the SEAL OF THE REGISTER Of DEEDS. In addition, a certified survey, if
available, would be helpful so as to avoid delays of the reviewing process. If
the deed description references to a Certified Survey Nap, the Certified Survey
Map shall also be required.
----------------------------
PROPERTY OWNER CERTIFICATION
[[We) certify that all statements on this form are true to the best of my (our)
knowledge; that I (ve) am (are) the owner(s) of the property described In
this information form, by virtue of a warranty to dprec`o recorded In the Office of
the County Register of Deeds as Document No. !� ; and that I (we)
presently own the proposed site for the sewage disposal system (or I (we) have
obtained an easement, to tun with the above described property, for the
construction of said system, and the same has been duly recorded in the Office
of the County Register of Deeds, as Document No. 1.
Signature of Owner Signature of Co -Owner (If Applicablel
C / 1 :V
Date of Signat re r
Data of Signature
DEPIARTM04T
INDUSTRY, REPORT ON SOIL BORINGS AND
INDUSTRY, AND PERCOLATION TESTS (115)
HUMAN RELATIONS
IH63.0911) & Chapter 145.0451
SAFETY & BUILDINGS
DIVISION
P.O. BOX 7969
MADISON, WI 53707
.0CATION' SECTION: �N' 1� / N/R IW TOWNS H1 P,MWALIQM# L IT Y T c. uNO.'.SU9O ISIO AM
:OUNTY
���j�1[L:�J se
GATES DOSE RVATIONS MADE
TESTS:
®Ratidenp ❑New ERep4ca I `/,''�`�� - L�
suitable for svwerrr U- Site trrwitable for
If Percolation Tools are NOT raotlir DESIGN RATE: If eny po•on of Me tested aru rt .n the
under s.H63.0916Y1'b1, indicters: FloadPlamn, indicate Floodplain ela.atran: Ae
PROFILE DESCRIPTIONS
�_•'..-
�-,,...
�a.rr��teDId�;1y1�•
• • - • a : r �
t4]rl:ILel:l#ii
r
PERCOLATION TESTS
RATE -A
- INCII
PLOT PLAN- Show locations of percolation tests. toil borings and the oimentions of suitable oil are". Indicate tale or duunces. Describe v"t am tna non
tontal and vartial sl ntation reference poinu and show their location on the plot plan. Show the Surface elevation at all boring% and the direction and percent
of land slope.
SYSTEM ELEVATION tr,•d .� r
Al Aw� Awe re
e t_ — r --F- -L r .A �f
y
7 TN
1, the undersigned, hereby certify that the 9MI tesu reported on khis form were made by rrw in accord With the 1t.dddu�
Adminirtronhe Cade, and that the data recorded and the position of the tests are correct to the part of my knowledge and
�iAl6id
A' 1. k
J.S
in the Wisconsin
DINTRIBUTIONI Original and one copy to Local Authority, Property Owner and Sod Tesl.r
DILHR-SO043951R. 02182) - OVER -
OWN
INSTRUCTIONS FOR COMPLETING FORM 115 • SBD • 6395
1n Ile a compete a•xl accurate sod vht, voul f eouit must inrlulte:
I. Complete Ic,)al (lest r,pllun,
2. The US IS 7C 1160rl riot deafly ,ndrf:ato wavy hef filar it a •rsidrrca fir cnmmercal prolrct.
3- MAXIMUM number of bedroum; or comnlercia' use , lmmell;
4 Is this a nett/ of I eplaermenr system;
5. Complete the suitahllety rating k>oxes. A SITE IS SUITABLE FOR A HOLDING; TANK ONLY IF ALL
OTHER SYSTEMS ARE RULED OUT BASED ON SOIL CONDITIONS;
6. PLEASE use the dbuls•iatinns shur•. how lot wasting profile de,ci.ounns awl erlropleling ,he plotplan;
1 MAKE A LEGIBLE filagram aeetuap!:V Ineati!,q your lost Ioeaur 1s. D!auvinfq to sralr is p.rh•rrrd. A
srparat.' Sheol may W. used If drsir,ld:
b Maf,r tpie yUu, b••nrhrllars an if ce,ti_al elwat In : IOff';"I.co Moult a1P f lvarly Shown. Anil at wrenamem;
ft Corripiera ad apll+llormie kxlxes as lu da:es. •tarw. aodlemws, flood 1m!" dald, 11CrrA 1:711pn test r•xelTmp
'ton, If appruprlalr.
10 it the Ionnal,o,: t;urh as IIouJ pl..in, r.1rva,,wil doer, not amply. piaGe N.A. In the appi qln .,fe i.ox;
It. Stye [lie ioi rn ,md Flair you, eu,rt•nt aJJ,e>s it J yout cerLlhCaLnn number
12Make frttibll' rnpu•-. )n.l fhslnitu:c as refn,ur I. ALI. SOIL TESTS ls1UST BE FILED WITH THE
I OCAL AIITHORI rY WI THIN 30 DAYS OF C:OMPLETION.
A31BRIEVIA1 IONS FOR CERTIFIED SOIL TESTERS
S.aI Sepa•ates anti Trxt... es
Oil.- Symbol.
t SI 1... ,'Or }q"I
f1R •- G-dvwk
rot C;.1bblr 13 to' I
55 S•InU,Iml
,I. [;..nil lu,uhm X 1
LS
S mi
L,ti47 H,uh lLuundwdtrl
I., C.,a•se Sd,.d
p •r P,•.„-!.,•ro• I:.lt.•
.11rJ . - fd.�diUr'• find
1'd .. '�I
F. w Saw
Lltdrt B .,tch-1
Is — t-doly Sold
> ri,cat- Tb.,.,
CI S•'ntlY Lf1a,T,
(- 1! S Ttlarl
.1 S, r Lua•l
l!I Etl Ir.
v S. I
Gy - ii-..v
Ael Clx, Lanni
Y Y I!f.1•.
s::! — s,"<Ty (Jay Lo.m
R — R..,!
::r•I - Stv Ual Lom:l
unut --
v S,luv Vol,
N, ._111
s.t — S•.ry GaAs
fit F•w. I,ro •ail,•
fl
rG11,1•1.0 ..l.,f•.r
r, „t
r'I'll - w.-y n'l•mur,
It, Mutk
t1 -- .0 .tlm.'
HVVL H,.th Aaatr. lrrrl,
• Six grnCl;l' roll teXttRCS
im 14Cr .�•1'I"
to, bqu,d wane fl.sposat
RM -- Gerch Ala, k
vilp E'r,tl.:nt n••inrvnrr Pont
TO THE OWNER:
Ghrs soil test report Is th.• hest rtrp nl srcurtng a sanitary pro nnt, Thr cclunly to fho Department may rrgor.st
vrf;ficalion of this sod tPil in the held prim io pennn k%uanrc. A cor,pleta svf of piam for the privaty
s•-v:age systenl and If nr,mu aopltcatnn must be. cuhmlttell lu IIW apn,Dillair local author fly i,I order to
ohlaln a Iler+llit. Thp san;taiv pwimtl musl Ife obta;ocd anti i osterl prrur to the start of any Cuns;, ura aril.
STC - 105
SEPTIC TANK MAINTENANCE AGREEMENT
St. Croix County
OWNER/BUYER ! t
ROUTE/BOX NUMBER FIRE NO.
CITYfSTATE ZIP
PROPERTY LOCRTION: S_1/4 .��_1f4, Section T,_N R_i;
Toxjs of , St. Croix County,
Lot No. �.
Impr use and maintem nce of your septic system could result in Its premature
fall q,.,han81e wastes. Proper maintenance consists of pumping out the septic
tank.eve three years or sooner, If needed, by a LICENSED SEPTIC TANK PUKPER.
What you put into the system can affect the function of the septic tank as a
treatment stage in the waste disposal system.
St. Croix County Residents MAY be eligible to receive a grant for a MAXIMUM of
$3000 of the cost of replacement of a failing system, which was In operation
prior to July 1, 1978. St. Croix County accepted this program in August of
1980, with the requitement that owners of ALL NEW SYSTEMS agree to keep their
„systems properly maintained.
The property owner agrees to submit to St. Croix County Zoning 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 (2) after
Inspection and pumping (if necessary), the septic tank is less than 1/3 full of
sludge and scum. Certification form will be sent approximately 30 days prior to
three year expiration.
I/WE, the undersigned, have read the above requirements and agree to maintain
the private sewage disposal system in accordance with the standards set forth,
herein, as set by the Wisconsin Department of Natural Resources. Certification
form must be completed and returned to the St.Croix County Zoning Office within
30 days of the three year expiration date.
/.P,
St. Croix County Zoning Office
St. Croix County Courthouse
911 4th Street
Hudson, WI 54016
(715) 386-4680
Sign, Date, and Return to above address
State of Wisconsin Department of Industry, Labor and Human Relations
SAFETY & BUILDINGS DIVISION
RF: Plan Number-. SOP 04001
i 1 4 1 1,
drill- I
i At I i 'I P1 I I j
ctllAf S MI r", 1 91'If
4"N u J-2
-0
SBD-6423 (R- D8/88)
I
t�
State of Wisconsin 1 Department of Industry, Labor and Human Relations
i %P
SAFETY & BUILDINGS DIVISION
!� •I 111' ::I �!i
. ( f t?�'V l it �• t i.'...'I'!:•1i.i 1. i
SBD-6423 (R 08188)
. -�
State of Wisconsin
November 7, 1988
Marvin Kirschbaum
Route 1 , Box 641i
New Richmond, WI 54017
Dear Mr. Kirschbaum:
Department of Industry, Labor and Human Relations
SAFETY 9 BUILDINGS QIViSION
201 E. Washington Avenue
P.O Box 7969
Madison. Wisconsin 53707
Petition No. S88-04801-P
Re: flary * Kirschbaum - Residence
Onsite Sewage System
SE,SE,9,30,17W
Town of Erin Prairie, St. Croix County, WI
Section 145.24 (1). Wisconsin Statutes, and s. ILIIR 8.Ug 0)-Tb),Wisconsin
Administrative Code, allow the owner to petition the department for a variance
to the installation for a onsite sewage system to replace an existing onsite
sewage system at a site which is not in full compliance with the siting
standards in the administrative rule. The systen design proposed should
protect the waters of the state from contarnination. If this system becomes a
failing system or contaminates the waters of the state, this variance shall be
rescinded.
The petition for a variance requested to s. ILIiR 83.13 (1) (d) of the Wis.
Adm. Code was considered on November 1, 196b. The petition has been
conditionally approved. The condition being that in the event of failure, the
mound system shall be replaced with a holding tank or other off -lot system.
The rule requires that a mound syster) have a w1nimum of 24 inches of suitable
natural soil.
The variance requested was to install a replacement mound system on a site
with 21 inches of suitable natural soil.
All of the data and statements submitted on behalf of the petition sere
considered. This variance is specific to the subject pettti0 e
used for any additional modifications.
Sincerely, ,
icZIM fleyer, Architect
Director, Office of Divi'iah ,
Codes and Application L,
(6M) 2b6-3080
RM:PEP:0970g
cc: Leroy Jansky, Private Sewage Consultant - District 6, Chippewa Falls
Thomas Nelson, Zoning Administrator - St. Croix Lounty
Calvin Powers, Jr., Plumber
8004M (R. 10117)
r
ST. CROIX COUNTY
WISCONSIN
ZONING OFFICE
ST. CROIX COUNTY COURTHOUSE
911 FOURTH STREET • HUDSON, WI 54016
(715) 386.4680
October 21, 1988
Division of Safety and Buildings
Bureau of Plumbing
P. O. Box 7969
Madison, WI 53707
Dear Sir:
An on site investigation for the Marvin Kirschbaum property
located in the SE 1/4 of the SE 1/4 of Section 9, T30N-R17W, Town
of Erin Prairie, St. Croix County, revealed suitable soils at a
depth of 1.75 feet, below which high groundwat er was noted.
This site should be suitable for a mound system.
Should you have any questions regarding this subject, please feel
free to contact this office.
Sincerely,
IG+.c,,o C. hJ J,5.Q►- I rS
Thomas C. Nelson
Zoning Administrator
TCN:rms
IV O vember
10,00
e,u e
1-1
Call}
REGEIVED
woo 1 1988
r • OFFICE OF OiViSIOi+���
11:5 —aye _sass
L . M
, r
Office of Dividion Codes and Ap'Ncation { �'
nd,�.rtmentoflndustry, ONSTTE SEWAGE SYSTEMS
• � t.abar and yt►man Relations { +ate sanvefM Mi s.eew�4
sarl" and Onldings Division ; 1 E. wmhingtolii,- .r 141 - A
PLAN APPROVAL APPLICATION t Be" 7"9. Madison. W f'31+07AL
2684815
r�',' fE1STMlCI7)billf: Please fill mall applicable data and submit this farm with plans. Plans will not be reviewfd until.alhfees art rlCeiMed. The '
=! re" Wo of this form describes most of -the required plan information Further requirements may be coAtamed in the Wisconsin fnuoribing
" Code, whkh an be purchased from the Department of Adminrstratron, Document Sales and Distribution, 302 South Thornton Ave., P 0 Box
7W, Madison, "S3707, Telephone (609)366-33S8.
A. PRQi1LCT INFORMATIOM(Type or print dearly)
Plan Number Previously Assigned
S ittm arty (plans urned same)
Tesll XO0 Box 0 orltufallitouie
k'
Project ame
Project Addy or Le ai Description
,City Village
RSate Zip Code
City ❑
village ❑ of
Town 0 J1iAA0jt/
County
`
Telephone No. (include area code) , p
Nam Owner
.?elephpne No (include area code)
Telephone No. (include a ea code
ess, P O. Box 0 or Rutailioute
Street dress, P.O. Box M ur Rural Route ,
y i!r a State Zip Code
r r
City Vi lag State tip Code
s!•
APATION FOR: l7Experinontai
S�
❑ , CoQ nstruction LargeStktem
�acament
❑ C
i r
(� At i irac*
❑ S
`..d'
�.
` Qf^Il�risi0n ❑ Pressurt�ed Systems
❑ S
f�COMPLITATIONS (Include existing tanks)
..
A6►,CHEBL CKS PA TO SAPE=Y i KHLOINGS Drt)ISIOFs
150 - 1,500 gallon septic thnk
S 5040
- b. ` 11501 - 2,S00 ept galluu sic tank
S 60-00
c. ' .. 2;501 - 5,000 gagdnsepercl>ink
S $0.00
d.•, 5,001 - 9,000 gaHon septic tank
$100.00
e., 9,001. 15,OGo gallon septic tpnk
S 1 S0.00
Over 15.000 gallon septic tank
$250,00
M
ound System
onventronal Gravity System
ystem in Fill
ystem in Flood Plain (attach SOD-6698)
❑ Ho►drng Tank 41
❑ Qloundw,%ter Monirkbnng s
Pritron Fp Variance 1
❑ t7Mher Atternabves
FEE SUBMITTED FOR OFFICE US$ y .µ
• J.. ,
•
`
�' •
0.
'4#
' i. ''•
j.
k.
I.
t
.. 300 - 1.000 gallon dose cliamber
-3001- 2,000 gallon dose cVpmber
` 2pt)1 - 4,001) gallon dose chamber
4,001 - 8,000 gallon dosr chamber
6.001 - 12.000 gallon dose chamber
Over 12,000 gallon dose ct)amber
S 30.00 f
S 5000
$ 7000
S 9000
$110.00
$150.00
M.
$00 - 5,000 gallon holding tank
! 30DO _
n.
5,001 - 10,000 gallotl holding tank
f S5.00
r,
r
o-.;
Over 10,000 gallon holding trink
S 10040
p.
Revisions
i 20.00
q.
Groundwater Monitoring- Per Side
S 32.00 --
ti
(other than a proposed subdrvmo(r)
r.
Petition For Variance: Setback
S 25.00
Site Evaluation
S SO.00
Subtotal:
s
Prhy Manevw Rie: Enter saran amount
for
es Subtotal
+.
Total fee
$BD-67ea(K.04 3B) NOTE Fey a purs�,ant to Wes Adm Cody. Chapter Ind 9, a d OVER »
are act to : hsnge a n i ually
ST. CROIX COUNTY
WISCONSIN
ZONING OFFICE
ST. CROIX COUNTY COURTHOUSE
911 FOURTH STREET • HUDSON, WI 54016
(715) 386-4680
October 21, 1988
Division of Safety and Buildings
Bureau of Plumbing
P. O. Box 7969
Madison, WI 53707
Dear Sir:
An on site investigation for the Marvin Kirschbaum property
located in the SE 1/4 of the SE 1/4 of Section 9, T30N-R17W, Town
of Erin Prairie, St. Croix County, revealed suitable soils at a
depth of 1.75 feet, below which high groundwat er was noted.
This site should be suitable for a mound system.
Should you have any questions regarding this subject, please feel
free to contact this office.
Sincerely,
tj
�.� �. h; �.,.ti,►, rs
Thomas C. Nelson
Zoning Administrator
TCN:rms
S 88- 0480I
f` :f ETITION FOR VARIANCE WISCONSIN DEPARTMENT OF
OF A RULE IN THE INDUSTRY, LABOR AND HUMAN RELATIONS
WISCONSIN ADMINISTRATIVE CODE DIVISION OF SAFETY & BUILDINGS
P.O. BOX 7969. MADISON, WI 63707
OFFICE USE ONLY
Petition No.
E—Number
E-
l.�i_
;0AM0.0
1 rSc?�au
Building Occupancy or the
A , tvip-Fiwn
7'yev �-
s
nyE
Tenant Name, if any
Street & No.
►valve
o
St No.
Building Locetio Street � No u f. ��
1 �(/•4v�A
"ily Ste ,p
atOl 7
Phone
City State Mip City County
S o/AI.WgAmbii,14
Phone
Plan Numberlsl
Name of Contact son
r -v? 14 -
k
IF KNOWN -� --
-
1. Rule /�- %� to 3e, the Wist msin Adminstrative code cannot be entirely satisfied because:
�—` ==� _ _w _ J /_� S � _ f� as,....• _ ....-� t y1,et...-.� — s-b•o�--L ��a. ►t1 o�—�q +.... — — — — —
All,
_,�,..Q...o ,__ _,7r_4--�'--'�PL�.+^�-�------------------------
--——— — — — — —-— — — — — — — — — — — — — — -----------------------------&+-i�� pi�1;10N�►1
cnI,I I
2. In lieu of complying exactly with the rule, the following alternative is proposed as a means of providing an equivalent
degree of safety:
�C-' -- F - ° ` s - -�r' v. S e - - !, s� S — a lr- — S Q .�(— t.v, S fie., 4 — 04— _ l_
ti_ ----—_--
----------- ------------ ---------------------10--------
3. Supporting atquments are: f
--—�£---a'1--JC
lCl�J�ir�� __—��a►'t—_�,�d L,;—_.1s _Nv
-------------------------------------------------------------------
VERIFICATION BY OWNER - PETITION 15 VALID ONLY IF NOTARIZED
For Fee Information See ILHR 69.15 or Contact The Department at (608)•267.7843
NOTE: Petitioner must be building owner, Tenants• agents, designers, contractors, attorneys, etc. may not sign petition unless a Power
of Attorney is submitted with the Petition.
grVltn Y-SCE
(NAME of PETITIONER Please t YPe/Print) being duly sworn, I state as petitioner; that I have read
the foregoing petition, that I believe it to be true and I have significant ownership rights in the subject building.
588-04801
OFFICE USE ONLY
scaj aturaof Owner Date Received Amount Paid Receipt No.
Subscribed and sworn to me this date:
/D
L1 x County, Wisconsin.
Department Action
Notary Pubtic Office of The Secretar Date
My Commission expit os: _ _ _
98-0IR 17/84)
r
1
INDUSTRY, REPORT
INDUSTRY, BOREPORT ON SOIL RINGS AND
LADORELATIONS
HUMAN
AND
HIJMAII PERCOLATION TESTS (115)
{H83M(11 R Chapter 145,0451
SAFETY & BUILDINGS
DIVISION
P.O. BOX 796E
MADISON. WI S37W
LUICAT I ,/
OWNSH rM441GPALITY
U
. NO.: SU VI NAME:
I
/ N/A (�
4WA
/,
uNr►
-S QlZ
we DATES ODSE RVATIVFIS MAUR
mRnlbnCe JyA 0Naw ®Replaq l 'le -.,J'8/
Ifltt sAdila for swtetn U- Sl,e unsuitable for system
ll Psi v at ton Tel, are NOT, DESI N RATE: 11 .nr Pomon of The the
under tst8].OBi61161, Imairu. �d�rd Ffoodpinn, Adicals, F1000010-n 61"St,en:
w._ PROFILE DESCRIPTIONS
e(X1lBE.
ELEVATION
T
AT iNum
1 11 THICKNESS. COLOR. XTU • AND D TH
TO R�DAOCK IF OBSERVED iSEE ABBRV.ON BACK 1
R _
B•
B•
B
ti v15tUN v
oitLlr PERCOLATION TESTS t�'<
�
�7
•.
-
��».rrn
�raaan:v�_r+d_r4�aal.cw:I3.�
slll�3ta[•r.3•allt��a.u.t-a•I�
( �
✓,r
�i�arn�ri���r'S��A�l��
PLOT PLAN: Show lutahoms of pereolellon teel,, sell borings and the dirnanfiont at jaitebla jail vest. Indicate enla or distances. Oeacribe whet am tM horn
ronUt and vertical efir"llon reference points and show thah location on the plot plan. Show the surface election at all banner and the direction and Pereanl
of Wind siren.
SYSTEM ELEVATION
X i ICd V 44ri 0 f S, A
1
DI{TRIBUTION: O••ginel aryl +n4Coov la Ll, l AUlhatity. P'00e1ty Owns, and Soil Tp.Ier
DILHR SOO-63UG tit. 07,d2) - OVFR
f w....�. w Tyr— - • _ � _ w � -._.i - .... � �_ �_ -r ._ �• �..�.�—.�.r ter► +ter �r
MEET - HOUND SYJ E DESIGN k �►
r. Ok:
thoslgn a hound system for a
' TO
site characteristics are: .
Depth to'.oun(*ter or baock;
:.
q t- % s;
Percolation ram
•��+ Dtstanu chamber *o distribution system - ,_ " ,,,[,.-
' Eleratiim 'diffettnce betwe* MwV and Oistribotion sy**- l
l 1;• h•
-i1 O ti r
ired �+� iioF �`/f/ f'• '�;' '.' .
o %trench w1d* (A)
t•
r, sr 1 : .24 tial/ft /day
3. MQWJ' HEIGHT
01
k = A) Rill pth (D) ft. ,C1�
.� B) Fill depth (E) ■ D + slope (Aj
',,• ,�:� �. , . �.. %oils' ,. ���'��� = �;�� .� (t:
C o trench dep%h
topoll dp ,
E}p topsoil d•pth(H) ;:: .'`,' ,. s, •'.� ,
. Stop 4.
MOUND LENGTH
A) End slope (K) ■ D + E + F + H x 3 ■ [ ft.
C--2
B) Total mound length(L)■ 8 + 2(K) t.
Mouho WIDTH 9� 7� t�C��) :- //s; �,�-
Al) Upslope correction factor
A2)Vpslope width (J) ^ (D + F + G)(3)(factor)
ft.
-, 83 t j (3) t, d 4� B ';Zz3E
61) Downslope correction factor •
�
52) Downslope width (I) (E + !: + G)(3)(factor) •
1t. A? '
C1) Total m+uund width (N) for bed J + A + I
ft.
r
C2) Total around width (W) for trenches ■
r'
J + + (no. trenches -1) (c) + + I �-4rt. 30, 3
Stop 6. BASAL AREA
A) Infiltrative capacity of natural soil ■c;,�,.9f °;�ti"}o��i.:.. pl./ft
P' jam•'
B) Basal rea re uired ■ wastewater flog i '
nature soil nfiltrativ ca city
9
s ft.
1�.%� q
.sue . �g ^'
�
CI) Basal area available for bed for sloping sites
B x (A + 1)
sq. ft.
a
.
C2) SasiJ-are4 avaikokle for trench for sloping sites ■ �8 �5_
8 W 4 (J + ■ - sq. ft.
;rS-x'4P-?, (J4 3,4,�7=
C Basal area available for trench or bed for level
si s ■ B x W ■
sq. ft.
Sirn:
Licansc i.0 • f _ �oPes�tb ,�.r$ .,
U
"
Date: .2J
Step 7.
'o
r.
A ='
3
DISTRIBUTION SYSTEM
7A) SIZE DISTRIBUTION SYSTEM
i) Mole site ■
in.
2) Hole spacing in.
3) Distribution pipe length ■ ! j.D�r�T
4) Distribution pipe diameter « Z in.
5) Spacing between distribution pipes in.
6) Distance from sidewall to distribution pipe + in.
7B), DISTRIBUTION PIPE DISCHARGE RATE
1) Number of holes per pipe ■
2) Flow per pipe •
7C) SIZE MANIFOLD
1) Manifold is ,,,- central/ and
2) Manifold length ■
3) , Neer of distribution lines -
4) Manifold diameter
7D) SIZE FORCE MAIN
1) Minimums dosing rate
2) force main diameter ■
3) Friction loss •
0 7E) TOTAL, DYNAMIC HEAD
1) Vertical lift ■
2) Friction loss -
f; 3) System head 2.5 ft. ■
4) Total dynamic head ■
3iUn:
Li.corse:.1-5
RECEIVED
Nov 1 1986
ft.
,...L ft.
ft.
a ft,`
ft.
sss-o4sQ1
f
19
7F) PUMP SELECTION
1) Pwg selected will discharge .&I GPM at ft.
total OynaMiC head.
2) Pump model and manufacturer
IAL_
7G) DOSE'VOLUME
1) ;0 9$CyC times id A f di ib ti n lines ga /cyde
gs—, r(
±!�=�
2) Daily wa'sCew6"u0 ater vol4me '-.T)7dozses/24 hrs. m I (Fj,
* 1
3) Minimum dose voluum- rk2jj&z-- gat./cycle
7H) DOSEE-CKWER
1) Minimum capacity required ga I
;r y-0
J.
�x
Aw
D a L e
RECEIVED
NOV 1 1988
OFFICE OF DiVISION
S88-04801-
• � f,�• ,5� off' /�
AIWAI
,17lavO S�R�' -
.S�jia
&W -
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ye
t
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I
REG�iiI�"
>�OV 119B5
OFFICE„OF D�r'iStON��
SEWAG� gf 5TEM
M.
S•
wn
Lr—
R�MEliA yr
4EPA D1 /
0� E
'B
401
S88- 04801
mo
► °' Straw, Marsh Way, Or
Synthetic Colterinq,
AMdlum
Topeolt �J—,-\4 — I ---
Sri flops - -- - - ..
Bed Of ��-2�
.. „
r+
Dhlribution, P40it
' -To
Force Maio
moo faOq e .
;
Cr as Section'Of A Mound System Using
A 'tis# For. The
Absorption Aria
A
�� ..
t
K Ft.
r
L.& �-Ft.
•
Alternate Posdtion
I _ Ft.
Of
Farce' Ma f
W . Ft .
` �Dls�ibUliOn• G �� Qt �"_ � �s
,. Pipe SEti Aagregat} ,
Observvlion Pik• VVIED Pormonant Mgr><ers
'
,y4•
15
�• fir. r80
Wan View Of 14ound Using A Bed For Tha Absorption Area P'
vi.
t '
3
[a1
Cq
1
�
/r
Loll Moe Should as
N"I To tad Gap
Parloraled Pipe Odell
be
f�rf,J h �Xscrl���
/Y a ,w i tI/nONp W
Moto l""olad On Ballon,,
Are tilrally fpoced
'r
*ECEIVED
�01 !GE OF DiVISIGN
OiUrifwhon Pipe Layout ql P M Ft.
Signed: . a aj -
License Number: �%
Date: ,P'�P..,-c gysmm
-- p�-•
S Of 1K4 0 " ' yj�1
_ � w
A�t
X � Inche%
Ic
Hole Diameter lnriz
a Lateral
Force Main " —X lnctw3
# of holes/pipe
Invert Elevation of LateralsA&-Ft.
,T1G1S
S88- 04801
"19N
TM�
1
r.
r1
O
h
R
�y
Q
FA
nR
H
40
e✓ '
pp,
b ..
rIt
4'C.I. VENT PIPE
:?t Z5. FROM ODOR,
WINDOW OR FRESH
Alit INTAKE
l0'Alm,
� IAJi..ET
APPROYLD JOINT
w/C.2. PIPF.
EXTENDIKJI: 3'
OWTO SOLID se"
PUMP CHAM ER CROSS SECTION AKIO SPECIFICATIONS
VCWT CAP
WCATmER PROOF
JUUCTIOM box�
I�'MIL1.
PAGE 2— OF 112—
�3
,�,Lr r✓ �C�.+.aw0 hiJ�
APPAOVED LOCKING S'�DJ�
MAWHOLE COVEK
I
GRADE
`1' MIAJ.
i �-
� IB'MIu.
col
71�
NGEg`t ROVIDf I -----
7 S�� Sr /f ftovi T SEAL I i 1
n , I II
A �. tin t1 ; 1 _ tiro I IAPPROVED imwTt
' �' � 7M •:.� ,.y � •t:� I I I W/G•I. PIPE
•f )'R '.7 4 I '
� � MM ``� �"'.1• t' �� I I I ALNKM CXTE►JOIuG 3
ONTO SOLID %OIL
I Owc E?PRAM`, aF ►uyy ._• � I
PUMP——, --� OFF
0 SEE GG�
rOUCBETE BLOCK
R SER EXIT PERMITTED 011l IF iA►JK MAMUFACTIl 3HASSUCHAPPROVAL
ILkt2g.1`1 ( �� P CIFI TIO 5 S O 8— Q4 8 U X
ifPTIC AND
JL_TANKS MA14UFACT UR,Cit: S 1JUMBER OF DOSES: PER I)As
TAWK '',IZE: �// � !� GALLOWS DOSE VOLUME 1-71
ALARM MAWUFACrURER:
IWCLUVIO!' CLC';FLOW: GALtl
MODEL UUMUR: �J. CAPACITIE ' A I1"L5 OR ., GALLOUS
SWITCk TVF1E= , � f B a IIJLHrn- Es OR '1�CoALLOkIS
PUMP MAMUFACTURER. �i_ , C ■ I E5 OR ,�, rA -,.OI,JS�, I
MODEL AJUMIC![R: 3 N D.Z1<1 IT,{CHESOR. GA LOAiL
SWITCH TyPC. OTE' PUMP AWD ALARM ARE TO 5C
PUMP 011CMARf.E RAT(%<J GPM INSTALL(D OW SEPActAT 1RCUITS
VEKTICAL DIFFERENC.0 ptl`9i' U PUMP OFF AWO 011TRIBUTIOW PIPE.. FEET Q q�
+ PAILJIAUM WETWOKK SUPPLY PKESIl RE , . . , , . , , , , , 2 ..5 FEET
♦ F[ET OF FORCE MAIN 1(�F%ppItFRICTIOu FACTOR.._ FEET pi'�iylbt' �i
TOTAL. 010JAMIG HEAD = 7' FEET
Go"
IUTERNAL DIMEIJ610A 6 0/ 5 All L,Ekl ;WIDTH ;LIQUID DCPTH
LICEAISE MUMBER:�1_�(P-� DATE:AkC_[l
Pi: �� -117-
.e -
`S 041.1Q
s� Submersible Effluent Pumps
ti--�llodel8
120 . �3
roc 100 0
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10.1
tih
pub) , !f
WPM03, n H.P.
dtL a '
1Afp03, V, H.P.
120
0 20 c,pacft a,won. r.IMkwt9 i
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