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040-1079-10-000
Wisconsin Department of-Commerce PRIVATE SEWAGE SYSTEM County: St, Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 538783 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: Bergman, John I T roy, Town of 040- 1079 -10 -000 CST BM Elev: Insp. BM Elev: BM Descriptio Section/Town /Range /Map No: /� PC /L �� —� 20.28.19 304A TANK INFORMATION j ELEVATION DATA TYPE MANUFA TURER l l CA ACI,TY STATION BS HI FS ELEV. Septic Benchmark Dosing —7 It. BM (� v / kh WAG 9 . 4 9 7i Aeration c o Bldg. Sgweer 5 /, C 1 3.0 / o, (. Holding S Ht In 0- • qo. St/Ht Outlet TANK SETBACK INFORNIATION TANK TO P/L WELL LID Vent to Air Intake ROAD Dt Inlet � Jfil Septic / Dt Bottom - 7 /GQ )too /D Z nIAn h 0 Dosing avl / vtch _p._ 2-0 / 4-1– &_111 Header /Man. } '10 1) Aeration Dist. Pipe 'Lk Holding Bot. System �r t ++ d PUMP /SIPHON INFORMATION I A'v b t CQnG 1 -t��2✓ Manufacturer Deman St Cover clyll GPI �- cfv-kl � U Io Model Number I G V? f �D Lift Friction Loss System e TD Ft �� cemai Len Dia. / Di s( to Well C SOIL ABSORPTION SYSTEM / �' c STCoYRZ BED /TRENCH Width Length No. Of Tre hes PIT DIMEN NS No. Of Pits I [ Luid Depth DIMENSIONS o'` +N SETBACK SYSTEM TO P/L BLDG WELL LAKE /STREAM C_LfiA6H6-� Manufacturer ( f�+ INFORMATION CHAMBER OR gad l Z • Typ 9f System: � S /,, UNIT Model Number n ( 4 DISTRIBUTION SYSTEM TI � l Header /Manifold Distribution x Hole Size x Hole Spacing ent to Air Intake M4 Pipe(s) Length Dia Length Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded /Sodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil ❑Yes :v No Yes No COMMENTS (Include code discrepencies, persons present, etc.) Inspection #1: �/ / / Inspection #2: /__/ Location: 306 Townsvalley Road River Falls, WI 540222 (NE 1/4 NE 1/4 20�T228�e es b Vunds Lot Parcel No: 20.28.19.304A 1.) Alt BM Description = d �� 2.) Bldg sewer length - amount of cover revis Plan No Use other side for additional information. I i SBD -6710 (R.3/97) Date Insepctor's Signature Cert. No. R 'CE D P t coltllmerce w gov — ( 11Safety nd Buildings ivision county JUN Q 6 8'1 1 W. Was ington Ave., P.O. Box 7162 : n ST. C IX COUNTY Madi n, W[ 53707 -7162 Sanitary Permit Number (to 6e fi n by Cn.) �ent of NNING &ZONING OFFICE 5 Sanitary Permit Application S tate Transacti mbar — In accordance with s. Comm. 83.21(2), Wis. Adm. Code, submission of this form to the appropriate governmental /" A _ unit is required prior to obtaining a sanitary permit, Note: Application forms for state -owned POWTS are Project Address (if different then mailing address) submitted to the Department of Commerce. Personal information you provide prey be used for secondary u n ies in accordance with the Privacy Law, s, 15.04(1)(m), Stilts. I. A Information - Plense Print All Information Property Owner's Name Parcel # r5e ry , �?� � ✓ 0 Y 0 , Property Owner's Mailing Address Pro perry Location --/ Govt. Lot City„ State - Zip Code Phone Number A/ y ,, VC _ ��,, Sect ion r I dprcl( 0n4-N m •11 pe or Building (check all that apply) _ Lot M ,ir 2 Family Dwelling -- Number of Bedrooms _ Subdivision Name - Block # ❑Public /Commercial -- Describe Use - ❑ City of------------- --- - - -- -- ❑ -- CSM Number ! >late Owned -- Describe Use ❑ Village of _ — Town IIL, 'rype of Permit: (Check only one box on line A. Complete line B if applicable) A' _ ❑ New System ❑ Replacement System at n Tank ReplaceinentDrily ❑ Other Modification to Exist ng System (explain) —0 XTY P, z 4, B. ❑ Permit Renewal El Permit Revision ❑ Change of Plumber ❑ Permit Transfer to New List Previous Permit Number a id Date Issued Before Expiration Owner ?$ j IV.. Type o f POW Check all that a 11 Mon- Pressurized In- Ground El ❑ Pressurized In- Ground At -Grade MoundUi of s su' itable sot' ' 'I L1 oM and < - 24 in. of suitable ,oil O l folding Tank ❑ Other Dispersal Component (explain)_ - -_ ❑ Pretreatment Device (explain). V. ))is ersaUTreatment Area I nformation: _ _ De:s gn Flow (gild) eaign Soil Application Rate{gpdsB Dispersal Area Required (sf) Dispersal Area Proposed (s0 Sys a t V'L Tank Info F I J Capacity in Total # of Manufacturer Gall Gallons Units New Tanks Fxistin Tanks n v w p g U rn 8 Sep is or Holding Tank - _ / _ _ 7 Dosing Chamber r '7 — - - JJ VI 1. Responsibility Statemen I the undersigned, assume r Ibillty for installation of the POWTS shown on the attached plans. Plumber's — arse (Print) e , Plumhr's - MP /MPRS Number Business Phone Number Plumber's Address (Street, City, State, Zip Code) V7[ .Count /De artm Onl y - - - -- - - - - - -- - - -- - - — - -- -- - - - - -- - - - -._— Approved ❑Disapproved Per� Fee Date Iss ed Issuing Agen Si aturo ❑ Owner Given Reason for Denial $ u ' 76 f �i �pprovallReasons for Disapproval /� �IlSTj �j 1 Septic tank, effluent filter and v �� � y.� fie&& x �s 11�e dispersal cell must all be servle�}, / malnts�lnt�d 4a4 tin�� CE��r� as per management plan provided by plumber. 2. All s etback requirements m ust be maintained �t o per app ici`able ca sa rM$lans for the system and bmlt to the County only,rtn pper no less than t t/2 III hee to e S.13D -6396 R. 01/07 Valid thru 01 /09�� ( 4 zoo 9 /° PLOT PLAN PROJECT John Beraman ADDRESS 306 Towns Vallev Road River Falls Wi 54022 NE 1/4 NE 1 /4S 20 /T 28 N/R 19 W TOWN Troy COUNTY ST. CROIX SYSTEM ELEVATION Existinq BEDROOM 4 CONVENTIONAL AT -GRADE CONVENTIONAL LIFT HOLDING TANK MOUND Existing SEPTIC TANK SIZE 1255 gallons LIFT TANK SIZE765 gallons DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE ABSORPTION AREA # of chambers BENCHMARK V.R.P. Corner of garage ASSUME ELEVATION 100° Filter BEST GF10 -8 ❑ BOREHOLE O WELL *H.R.P. Same as Benchmark AL 1320' Property Line WEII >200' Existing Pole 25' Building 300'+ 15 ,�te,nn 1 Existing Weiser 1250/750 tank /ll" � Existing Mound 5 ' Huffcu Comb k 60' 10' 40'Q 0� Pro 4 Bedroom House G� Property Line PLOT PLAN Page -? of Scale 1 "= yp' 6 -40454 U VY* 1 y �F i � n r Zs - �'�' � \ �� t'l ltv . y Z 3 �Cn u� e • \ 1 OR LtJS Q%- g i PC T?- F*a I t Flr oST S t M 5 lS 'CF V 4 PUC s -3 ra \ l p Q Vj �D rb tV So o Wl s -z � Q UY�DY t o F S ' a L Zbso� I 260 f Q NOTES 1. Elevations shown are existing ground elevations unless otherwise noted. 2. Install permanent markers at end of each lateral. ( y required) 3. Install 4" observation pipes with approved caps. ( Z required) 4. Septic tank to be1 Z50J7S0 gallon capacity manufactured by W U-- S Ell Cps e-MTS fL Z't 1v C--T 5 5. Bench Mark LOO 0' oQ SP) )b" p3ovi� GMUUb )ti S 'b] 1 6. Divert surface water around mound to prevent ponding at the uphill side. Cover Page Shaun Bird = Bird Plumbing Inc. 1008 192nd Ave New Richmond Wi 54017 715- 246 -4516 Date: 6/5/11 Owner: Bergman, John Location: NE1 /4 NE1 /4 S20 T28 N,R19W 306 Towns Valley Road Troy System type: Replace /A ddition of Tank, o nly Manuals Used: Pressure Di stribution Manual Version 2. Page# 1. Cover Page 2. Plot Plan 3. Tank cross section 4. Pump Curve 5. Filter Specificat' Sheet 6. -7. Maintance ontingenc plan Signature License n er #226900 PLOT PLAN PROJECT John Beraman ADDRESS 306 Towns Vallev Road River Falls Wi 54022 NE 1/4 NE 1 /4S 20 /T 28 N/R 19 . W TOWN Troy COUNTY ST. CROIX SYSTEM ELEVATION Existinq 4 BEDROOM CONVENTIONAL AT -GRADE CONVENTIONAL LIFT HOLDING TANK MOUND Existin g SEPTIC TANK SIZE 1255 gallons LIFT TANK SIZE765 gallons DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE ABSORPTION AREA # of chambers BENCHMARK V.R.P. Corner of garage ASSUME ELEVATION 100' Filter BEST GF10 -8 ❑ BOREHOLE O WELL * H. R. P. Same as Benchmark 1320' Property Line WEII >200' Existing 0,91 Pole 25' Building 300 B. M.* 15' Existing Weiser 1250/750 tank Existing Mound 50' Huffcutt Combo Tank 60' i 10' 40' Pro 4 Bedroom House Property Line Septic -Dose Wank Cross Section And Pump Performance Specifications Tank Manufacturer c Pump Manufacturer Tank Model Number DO 7s -0 Pump Model Number Total Tank Capacity ! ' Y&17 6j Alarm Manufacturer vQ S /per Max. Bury Depth Alarm Model Number Switch Type Filter Manufacturer ", Tot Dynamic Head (TDH) - Feet Filter Model Number Elevation Head Distal Pressure Network Loss Al /¢ Minimum Pump Performance Required Force Main Loss S7 D GPM / Ft TDH Total 1491 "" Outlet Manhole Min. 4" Above Grade With Locking Device. Inlet Manhole Manhole Min. 4" Above Grade < 6" Below Grade Sealed Watertight Securely Mounted With Locking Device Weather -proof I Junction Box -- Finished Grade — — — -- — — Vent Min. 12" Disconnect Above Grade Means With Vent Cap Outlet Filter f Inlet ;.;. �-- Inlet Baffle --- Switch Settings and Reserve Capacity `� ' /a" IX _ IX Tank Volume= GPI Weep Dimension Inches Volume Gal. B Hole (reserve) A' (alp) B 2 3Y' Elev ti on C Ft (dose) C "7..,S Id - � -♦ Bottom (dead) D IS j D T E evation Total ,� 7j Ft GENERAL INSTALLATION: The septic /dose tank is bedded and back filled in accordance with the manufacturer's product approval specifications. Maximum depth of bury as specified by the manufacturer may not be exceeded without prior approval. Manhole covers exposed to grade have an effective locking device (padlock) installed. Tiping at the inlet and outlet is of approved material, connected to the tank with watertight fittings, and laid on stable soil to prevent settling or sagging. The force main is sleeved with 4" Sch. 40 PVC to bridge the tank excavation and the sleeve is sealed watertight. Electrical service complies with NEC 300 and Comm 16.28. 02/05 LJ Page 3 of �_ TOTAL DYNAMIC HEAD/CAPACITY PER MINUTE HEAD CAPACITY CURVE EFFLUENT AND 'DIWATERNG MODELS 5,5/55/57/59 25 lViDdel 1 53 6- 20 FL Meters Ars. ?.5 5 43 15 - — .3 - , 34 7� I - 9 72 — T t — rs 5 43 Shut-off Hea 19.25 ft. (5.9rr 10 2- S 6 5/32 19 - t 4 4.6 l 9 2 4 5/B 1-1 1 1 '-/2 /2 NPT L '0 0 20 30 40 50 GALLONS 15/16 LITERS 8 . 0 160 FLOW PER MINUTE A 1/16 A L Variable level flclat switches available. Variable level io Ig cycle systems available. Available with soecial cord lengths of 15', 25', 35' and 50'. � ��___i �k� -- Alarm systems available. 10 Duplex systems available. 3/32 SKS58 )Lin) - - C ontrol Selection — CSA 1. integral float operated mechanical switch, no external control required. Model Vo is --- Plis - e Mode Amps simplex Duplex �Mj55 6 �M5 �15� Auto . 9.7 -7 1 y y 2. Single piggyback•vadable level float switch or double piggyback variable level _ N53155 9. � . 2 Au _ o . o 2 or 4& —5 Y Y !N5W59 Y floif BN53 - 3 Mechanical alternator "M-Pa' 10-0072 or 10-0075, N Y BN57 15 4. See FM0712 for correct model of Electrical Alternator. IBE53/57 Auto 4.8 y 5. Variable level control switch 10-0225 used as a control activator, with Electrical - b - WE5 — &D67159 2 io Auto 48 -- E53 - 155 & f 3 c & 5 y Y Alternator (3) or (4) float system. 5-7 159 - - --- — 2- Single piggy back switch in :hided. For information on additiona Zoeller products referto catalog on Piggyback Variable Level Float Switches, FM0477; Electrical Alternator, FMO48 3; Mechanical Alternator, FM0495; S Basins, FM0487; and Single Phase Si Pu Control /Alan a Systems, FM0732. For unusual conditions a reserve safety factor is engineered into the design of every Zoeller pump. MAIL TO: P.O. 80X,jf\147 A- Louisvdle, KY 40256 Manufacturers of. % 0 SHIP TO.• 3649 Cane Run Road LouisWile, KY 40211-1961 PUMP h Up. 1A,,, Cam 1(502) 778 - 2731.1(800) 928 PUMP FAX (502) 774-3624 Copyright 2002 Zoeller Co. All rights reserved. m TJ�t • ® z • A g� o C') ai c v O .1 Lfl N O O N W i0 W � � � r T T Z i r A v T T 8 _5 omm -- 8 --L " -L m r 000 N rn & Z G) 0 Zi A � D Z m STC -105 SErf 1C TANK MAINTENANCE AGREENE N St. Croix County OWN)E:RlBUXE.I2 — J OVv\ MAD ING ADDRESS q0 q �0,.OeO -. N E IM 5 5 3 oi{ J ROPER.TY ADDRESS �� r CI I J (location of septic system) Please obilin f prn the Planning Dept. CIT'YISTATE e r � L-) T r rROI'ERrY LOCATION C 1 14, 114, Section TOWN OF ST. CROLX COUNTY, WI SUBDIVISION LOT NUh1BER CERTIFIED SURVEY MA1' , VOLUME �� PAGE , LOT NUMBER Improper use sued 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 deeded by licensed septic tank pumper. What you put into the systetu Can affect thOf unction of the septic tank as a treatsuent stage in the waste disposal system. St. Croix County residents may be eligible to receive a grant for a maximum of 60% 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 requirement that owners of all new systems agree to keep their system properly maintained. The property owner agrees to submit to St. Croix Zoning a certification forth, signed by the owner and by a relater plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on -sits: wastewater disposal system is in proper operating condition and (x) after inspection and putnplrlg (i i1CCCssary), the septic tank is less than 1/3 full of sludge surd scum. UWe, the undersigned have read the above requiremeats and agree to maitltain the private: sewage disposal system in accordance with the standards set forth, herein, as set by the Wisc -onsin DNIt. Cenification stating that your septic has been maintained must be completed and returned to die St. Croix County "Zoning Officer within 30 days of the three year c rati date. SIGNED: r DATE: St. Croix County zoning Office Government Center 1 101 Carmichael Road !Hudson, WI 54016 11/93 G T PLAN �`est _..� at y PU1WT OVVNF -WS MANUAL $� MANA GJKCATK)i+iS Sipe got 0 NA F4T.JE tN!`C)NtAA'� � - 6eptfc Tsesk L ` ' o To* M ❑ NA �'+ertt#� �(tictettt ' Mme - S _--�. a �► i P�� ` CY �1 o NA 13 NA rrof � Ptmtp Tt* C� �� --� *0 4 w of GOMOwrGw obits Pomp TOt * MwwhwhM NA Oxx fE�ena�sd x i.$) — S .3 DNA o MW p Unit _. ems ' Mom raw v FRW o Peat FIN w r & Grsewe ) rte a Mec h*nlW ' d p > 1220 nV/L ❑ Dbkdsdba so TGW OLwpw%ftd 98kCOd s . - lMvrlthtY tee M 8T D !rt- grvcreu! (pr,eessart P t GLOB" 17s) S30 mglL D nd (Q�+hY) Ord ��/ -s � omw �i0 mg/l. ne O Other �. t Tow � s caft (MS) CW1 t�trii O 4orearnrNrc t� �p wes6nawes ■ w 3j inchdiametsr vslw�i �dm,urn Eilltrerd psr�a ' vsrws by r"a�rwaLr` «. tVYAtNTENI�'t 9CmWULE Eviret D months s) pawdi nu rn 3! nrs.} swvfte of tank(s) At least onaae e� Y psis one.4W d (Ig of t o K volu me,: When combined sludge and SCUM sq Pump out ©oe"nb of ta"W's) C7 ,rnonthat r(s) {trArud, Horn 3 r rs.) celi(s) At least otrrco ewtry s) srespset dope" At =kWtSt once ever Y t3 tszcmlh� Fesrt f titer 0 rnond s} O NA Rt once en+"erY Q S ) 13 YOOK t+EA insp� P!U"p teems At ' a'tern+ least otsce every s) Mus7 rnd P �r'Ei � { Or ears) O Nil _.....�. -- At lerast once a�rerY D moms O mss) DNA At bast anm even/ v �ur piss of tit ►1NY[t �CnD 0 8" std tae rr:ade by indiVtdlJai rt9 pdW't'S . ! vsps vt P t�t(�e�, Maa�ar pkav* +t' Rss6idod Sow' 1d am t " �` Tank n tnue� icaCludES a v bees g of tt�B !an scu and to for I MY bo °p MOB SU eihe vdu". ,af ec�rrtbtneid O&W96 k, chsde a» eI Auent leis trardwarm ideedKy tm!► s or Ttt disyss'BW Owe) s*09 be v !' � of aan �C ors tr+e ,,r porr�rlQ o f iA1We�rt t}ra 9�d tray area+ p of sousKtt an do am" � the � wry suttsort�, = dmcx 3n tw ob�e� s � ri tuu3 regctee+ds the Imrned a no r' awfaoa e Y one -!hind f$3 or mote of the tsntc rte, - it's vvw In c�orrtlbi wd � of d m � D�eratar and disf of in sue' �' � ,. Nth eaft of" N* s� be t OxMvns� -, and 811Y 13. wbr>QiciW A�dm� C�i°`- � or prMwjpd PoWTS compowts. Pfwm POWTS }Jaitakor. Of 9 �� of. month$ Or Shaft t Wtttod by a WIW c,elerm�t� a �la7 as�torHy whin 10 � Of oampietro� 0"gnt A SWWge ,Wt SW . be P vWded to tits tacai � 7 ofp8 produ� �s a other START UP N O OP Ea AT1Ol'1! ert# tank45 � � P ue For new canwiv w. p� to . of the pOWT'S dtadc,treatlln , 1! high c r4mbown s 2 m ey irn then V w�&nWd s andfar dWr*ge # 0 dbper� to use 6,W of ties t s) removed by a sePSt9e senAdng prior tietet�9d i>z Sn+ Gan jants A Page Sysftun s tartup shalt not occurvltaen svi{ "conditions are frozen at the infiltrative su purir,ci Ili Pip tBnICS tttsY flu I above nonnai highwater levels. When poWW is MSfiOred the 10710 SS ceu(s) in one large dace, rnteriaadirtg the t� {s) altd gray r�esu tin the wasu;W" r a will be d t o the d t� � ff�is situation have the contents of the primp f�tak f8MOVed by a tradoup or atr[acs die aF tv the effluent pump or contact a Plumber or POV1irr S M 01tairw to sq aae Setvk by Opp ptiD[ tiD P assist in mnually Ong #0 purnp caor bi* to restore normal levels v! Win the pump tank. Do tuft: dries or park and dt� t Do not drive or park Wer. or 099 twtse disbilrb c is compact, the 91110 wffign 15 feet down slvpe of any motmd or "rade soil absorption ama- Reductiout or - efunlrtattlon ot um offowhv from the wastesaattar shwm may imprnve the Perfortnanoe and prW xig die rite of tht: POWTS_ Ant JI bunts; condoms; cotton swabs; degmasets; dui tlOss; do 1pets; deintictanfs: fa' fofulidsGor+ dt'8 h {Bump p unP} water, fruit and vegetable peerr9s. ; 911 tretb(d des; meat scx,wtr ; mss; O4 n9 f : wades; sanitary napkins: tampons - . - eW taratersoftener bdne_ ABAN1143 OMENT When 3:he POWTS falls and/or iS peMl awntly .taken out of service the follMng steps shad tp taken to insure that the systerl, is prupedy safely abandoned in compliance with ch- Comm 83.33, Wisconsin Adn1bWrafAM Cod0: • Alt pipkig to tanks and ptfs shalt be disconnected and the abandoned pipe openings seated_ • The contents of all tanks and pft shall be removed and property disposed of try a Septage Senddng 4 3perator_ • Alter pumping. a ll tanks and pits shall be excavated and removed or their covers ,removed -and the vo d spebe fulled with soft, gravel or anogwr inert solid material. CONTINIGEIYCY PLAN' if the fNTWrS tans and cannot be repaired the following measures have been, or must be taken, to Provide a - :ode compliant repiacement system: ❑ A suable neplacaement has been evaluated and maybe utilized for the location ofa replacement soil absorption systwn- The replacement area should be protected from disturbance and aomPacilon and should not be infringed upon by required setbacks from existing and proposed structure, tot lines and wells. Felft re to protect the replacement area v!tili result in the need for a new soil and site °evaluatiarr to establish a suit able replacement area. Replacement systems must comply with the rules in effect at that time. ❑ A suitable replacement arrea is not available'due to setback aridlor soil limitations. Barring advances hi POWTS technology a holding tankmay be irrstaUed as a fast resort to replace the failed POWT$_ ie site has not been evaluated to identifY a suitable repiac e-ment area- Upon 'Failure of the POINTS a sor7.and site evaluation must be performed to locate a suitable replacement area, tf no replacement area is avr iiiable a ualding tank may be installed as at last resort to replace the failed POW rS_ and at -gmde sa absoW fon Wy +.Mound tems maybe r eWn-structed in place fiolkrMng removal of the bi 3mat at e irtfrltrativ8 surfe!cae_ Reconstructions of such systems must comply with the rules in effect atthat tine <- <WARh'1NC>> SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN L.ET14At: GASSES AN131f)R INSUF`FtCI ]li3' OXYGEN. OO NO - r ENTER A $EftnC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES_ DFJ :M MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE 1)[ErSCULT OR IMPOSSIB LE. ADDiTt01'9AL COMIYISM POWTS IN STALLER POWrS MAINTAINER --� � r � Mar Name . ��? ��`1� � i="" L p -- _ J _ p ho SEPTAGE .SERVICING OPERATOR PUMP LOCAL REGULATORY ktllNORf fY Rtame r Agency PhoneS"� J� Phone 7/✓ = '��� _ ____, This eoo�.ne� des di d 15), tree sm�tlaa of the Glraeo Lake. , 4=justra and Waushara County Zvnrng and SarrrTation _ Thls dOLXN rant melts the rnWML' e, iegauemerrts d dL Came Imo-- fN)( and 83-- & (3). DYcscortsin •ArtmrrHsTrariro Ccde- rise of ttr& doeume! et does nOt guarantee M!: perfmmanc a of the POWTS. GMw (Zml) 6 T C - 300 This application form is to be completed in full and signed by th owners) of the property being develop only result in Bela s oP Any inadequacies will develo merit be y the permit issuance. should this P intended for resale by owner /contractor, (spec house) , then a second form should be .retained and completed when the property is sold and submitted to this office with appropriate deed recording. h the -- Owner of property A"V ( wtuv% Location of property I / 1 f4, Section o?� , m Township j r� N'R 'l W Mailingaddress l goy1 Address of site .Subdivision name Other homes on property? J Lot no. Ye Previous owner of property A Total size of property LvU Total size Of parcel Date parcel was created Are all corners and lot lines identifiable? No Is this property being developed for (spec house) e ? yes Yew _ Volume } yes X No U and Page Number � a as recorded with the Register of Deeds. INCLUDE WITH THIS APPLICATION THE FOLLOWING: i A WARRANTY DEED which includes a DOCUMENT NUMBER, VOLUME AND PAGE NUMBER AND THE SEAL OF THE REGISTER OF DEEDS. certified survey, In addition, a if available, would be helpful so as to avoid delays of the reviewing tion references to a Ceztifg d Survess� If the deed descri p shall also be required. y Map, the Certified Survey Map # PROPERTY OWNER CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) knowledge that I we am (are) the Property described in this information form, by w virtue O of the a deed recorded in the office of th Deeds as Document No. 113'33$4v e Coun Reg ister r of own the Pr'opose'd site for the sewage �disposal O T ently obtained an easement, to run the above described pro pert (We) construction of said system, and the same has been duly recorded i the office of the County Register of Deeds as Document. 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E « % 2 \ \ OIQ. E\ 2 m T j m / 7 (D ° k j (D c c N) CD . C CL \ N / { { z z § ) § g > > CD R \ \ \ § \ . } G R ; < c a ƒ @ _ � / k \ � k / ƒ \ k { � \ \ � \ § § N 0 k § X \ / ® . � \ ==mN) > \ ` @k ^ ± ! n.CD 0 § . eeem - \ ID IL ¥) §. \ e . CD CD <m C -1 In 0 2ow k 0 0 2 (D \ ; &Egg # ID S =3 \ i =3 o u GHEE \ @ o 0 / g 0 , , x G > m \ o \ % 'Parcel #: 040 - 1079 -10 -000 10/05/2007 09:43 AM PAGE 1 OF 1 Alt. Parcel #: 20.28.19.304A 040 - TOWN OF TROY 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 JOHN T BERGMAN O - BERGMAN, JOHN T 306 TOWNSVALLEY RD RIVER FALLS WI 54022 Districts: SC = School SP = Special Property Address(es): " = Primary Type Dist # Description 306 TOWNSVALLEY RD SC 4893 RIVER FALLS SP 0100 CHIP VALLEY VOTECH Legal Description: Acres: 24.000 Plat: N/A -NOT AVAILABLE SEC 20 R28N R19W 24 AC S 48 RIDS OF NE NE Block/Condo Bldg: Tract(s): (Sec- Twn -Rng 401/4 1601/4) 20- 28N -19W Notes: Parcel History: Date Doc # Vol /Page Type 05/13/2002 678835 1889/290 WD 07/23/1997 1140/222 2007 SUMMARY Bill #: Fair Market Value: Assessed with: 0 Valuations: Last Changed: 07/20/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 2.000 48,400 49,300 97,700 NO PRODUCTIVE FORST LANDS G6 22.000 115,000 0 115,000 NO Totals for 2007: General Property 24.000 163,400 49,300 212,700 Woodland 0.000 0 0 Totals for 2006: General Property 24.000 163,400 49,300 212,700 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch #: 220 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER Tnhn Bergman ADDRESS 306 Towns Valley Road River Falls WI 54022 SUBDIVISION / CSM# LOT # SECTION 20 T 28 N -R 19 W, Town of Troy ST. CROIX COUNTY, WISCONSIN PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM 5 P rl G fl I f INDICATE NORTH ARROW Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center of septic tangy; manhole cover. ��' �� ��� � h 1� �� � � � . �� � �� ,� ,��' �`' � �� �',� � _� �; I ,� ,.; I' � .. � i 'A '� A � ! � �\ ' _ i J� A, � s an Hu man Rel tions of Industry Gab PRIVATE SEWAGE SYSTEM County: or anc� Hua Safety and Buildings Division INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Sam aryPermi o.: Permit Holder's Name: 262383 11 City ❑ Village [ Town of: State Plan ID No.: .3ERGMAN JOHN TROY CST BM Elev.: Insp. BM M Elev.: B Description: Parcel Tax No.: / �� �� `i . A9600189 TANK INFORMATION LEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. peptic ol 7 Benchmark Dosing &lAk4eA yga— Aeration Bldg. Sewer Holding St /Ht Inlet Zo1! TANK SETBACK INFORMATION St /Ht Outlet TANK TO P/L WELL BLDG. vent to ROAD Dt Inlet Airintake Septic NA Dt Bottom Z Dosing NA Header / Man. Aeration NA Dist. Pipe Holding ^ 11 9 W3 Bot. System 20 /— 99 F3 , PUMP/ SIPHON INFORMATION DT Coyer L,o 8.6y ` � Final Grade �• Manufacturer emand ' �k C IS• 2 Model Number GPM TDH Lift�.F33 L Friction System TDH Ft Ff Forcemain Length Dia. Dist. To Well SOIL ABSORPTION SYSTEM BED / TRENCH Width Length No. Of Trenches PIT No. Of Pits — DIMENSIONS Inside Dia. Liquid Depth DIMEN I N SETBACK SYSTEM TO P/L BLDG WELL LAKE /STREAM LEACHING Manufacturer: INFORMATION Typeo CHAMBER System: OR UNIT Mod Num er: DISTRIBUTION SYSTEM Header /Manifold Distribution Pipes) x Hole Size x Hole Spacing Vent To Air Intake Length Dia. Length Dia. Spacing SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over Depth Over xx Depth Of xx �Seeclecl /Sodded xx Mulched Bed /Trench Center Bed /Trench Edges To soil P es ❑ No ED] Yes ❑ �N, COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: TROY.20.28 NE, NE, TOWNSVALLEY ROAD 4f ftUrL4,,� Plan revision required? ❑ Yes Cd No Use other side for additional information. J r SBD -6710 (R 05/91) 'f C Date In ectorrs Signature Cert. 1 1 , s efetyandBuildin g Watr D iv i s i o n SANITARY PERMIT APPLICATION Bureau of Buildin Water System 201 E. Washington Ave. In accord with ILHR 83.05, Wis. Adm. Code P.O. Box 7969 Madison, WI 53707 -7969 • Attach complete plans (to the county copy only) for the system, on paper not less County than 8 112 x 11 inches in size. St Croi See reverse side for instructions for completing this application State Sanitary Permit Number The information you provide may be used by other government agency programs E] Check i r iSi n p r.� H p mn (Privacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number I. APPLICATION INFORMATION -PLEASE PRINT ALL INFORMATION S96 -40454 Property Owner Name Propert Location John Ber NE 1/4 NE 1/4, S 20 T 28 , N R 19 W Property Owner's Mailing Address Lot Number Block Number 14047 Yancy Street Northeast -------- City, State Zip Code Phone Number Subdivision Name or CSM Number Ham Lake MN 55304 ( > ----------- II. TYPE OF BUILDING: (check one) ❑ State Owned Nearest Road E] Public 1 or 2 Family Dwelling - No. of bedrooms Town of o 111. BUILDING USE (If building type is public, check all that apply) Parcel Tax Number(s) 1 ❑ Apartment/ Condo /0 - 7 9 ,/0 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. [M New 2 ❑ Replacement 3 E] Replacement of 4 ❑ Reconnection of 5_ ❑ Repair of an ------ System ________System _____________ Tank Only______________ Existing System Existing System B) ❑ A Sanitary Permit was previously issued. Permit Number Date Issued V. TYPE OF SYSTEM: (Check only one) Non - Pressurized Distribution Pressurized Distribution Experimental Other 11 ❑ Seepage Bed 21 [R Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 ❑ Seepage Trench 22 ❑ In- Ground Pressure 42 ❑ Pit Privy 13 ❑ Seepage Pit 43 ❑ Vault Privy 14 ❑ System -In -Fill VI. ABSORPTION SYSTEM INFORMATION: 1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Perc. Rate 6. System Elev. 7. Final Grade Required (sq. ft.) Proposed (sq. ft.) (Gals/day /sq. ft.) (Min. /inch) Elevation 600 1 .34 98.5 Feet Feet VII. TANK Capacity INFORMATION in gallons Total # of Manufacturer's Name Prefab. Site Fiber- Ex er. Gallons Tanks Con- Plastic p New Existin Concrete strutted Steel glass App. Tanks Tanks Septic Tank g kbddkjg)bn*C 1250 1250 1 Wieser El ❑ ❑ ❑ ❑ ❑ Lift Pump Tank N10 000t0cKWw 750 750 1 1 Wieser ® ❑ ❑ ❑ ❑ ❑ Vlll. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name: (Print) Plumber's Signature: (No Stamps) MP /Vo.: Business Phone Number: Paul C.J. Steiner 1 6780 _ Plumber's Address (Street, City, State, Zip Code): N8230" 945th Street; River Falls, WI 54022 IX. COUNTY / DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (includes Groundwater ate Issue Issuing Agent Signature (No Stamps) ;( App roved Surcharge Fee) roved ❑ Owner Given Initial e � Adverse Determination 0 ) X. CONDITIONS OF APPROVAL / REASONS FOR DISAPP SBD -6398 (R. 05/94) DKT'RIBUTION: Original to County, one copy To: Safety & Ruildings Division, Owner, Plumber Page of b MOUND SYSTEM FOR A BEDROOM RESIDENCE ,,,. LOCATED IN THE NF 1/4 OF THE NE 1/4 OF SECTION Z ,T N, R 19 W, TOWN OF TZO�( , S C1?_0 lK COUNTY, WISCONSIN. INDEX PAGE 1 'of 6 TITLE SHEET PAGE 2 of 6 PLOT PLAN PAGE 3 of.. 6 PLAN VIEW -CROSS SECTION: PAGE 4 of 6 DISTRIBUTION PIPE LAYOUT PAGE 5 of 6 PUMPING CHAMBER PAGE 6 of 6 PUMP PERFORMANCE CURVE RECEIVED PREPARED FOR MAY 2 11996 SAFETY a ly 0`lT ` , -1 C�'►�l L R l�C, w� ►v _ s s o y PREPARED BY WE !E C I L TEST I NG PRIVATE SEWAG AIM ���e®arano ®pl iti = �tv E31 "" sc At left n alft sm 74 421 N. MAIN ST.�•• '• F&U. NI 54022 i`► AnTHUR L. ?p V:EGERER a+ 2`x0165 _ Es ; p�prj, OF 1'mDus BY, lAB R Nr� BUiLM1403 Mj i wrs. N�SAf i SPONDEN C SE CO % Jose"& JOB NO. 6- S PLOT PLAN Scale 1 "= yp' Page Z of {�� @ � ) e - 40454 ��` CS tP h TL I 1 o r I o 1S o� V "PVC I J *4— [EI e-3 o a w l m lti1 �� `tU PcT LOST S o i= o wl L Z s_ W1UVYv 1� rW LET Z S ' g.Z - 2 9 l�Z-U w'1 TYC�•�12 5 . _ "'11I,1Z °lQ0 IC 400 1 l000' L L �bsv� ... x N S LTE. (` Zbyp� �4 NOTES 1. Elevations shown are existing ground elevations unless otherwise noted. 2. Install permanent markers at end of each lateral. ( V required) 3. Install 4" observation pipes with approved caps. ( Z required) 4. Septic tank to be \ Z50/750 gallon capacity manufactured by W LQ!5 E 'jZ C)IJ c-R PrLZ Dv C.T 3 5. Bench Mark iZ . LOO.& OQ SPIV-LL )6'` pn3ovl GMUKib lAv S" DiA 'r1 6. Divert surface water around mound to prevent ponding at the uphill side. Page 3 Of Approved Synthetic Covering Frs- C- 33 Distribution Pipe Medium Sand Topsoil - _ H_. G J - -- F Elev. . 3 E P b b % Slope Bed Of 1-2 %2 Force Main Plowed Aggregate From Pump Layer D 1•D Ft. Cross Section Of A Mound System Using E 1 -3t Ft. A Bed For The Absorption Area F Ft- G Ft. A 4, Ft. H \-S Ft. Linear Loading Rate = - I•) GPD /LN FT B BY Ft. Design Loading Rate= o• 2q GPD /SQ FT j \S Ft. J _S Ft.. I 7pq K l Ft. I7 b A4 - `1- i t t pq �OAD 0.3 � Y ..... .. �,�,� Ft . L l,o b -of-. k — F GFG , M, < W z 9 Ft. L Observation Pipe 13 K A - - - W o - - -- - Force Main Distribution Bed Of 2 -2.- Pipe Aggregate Observation Pipe Permanent Markers (anchor securely) Plan View Of Mound Using A Bed For The Absorption Area Page Of L Perforated Pipe Detail 0 End View Perforated End Cap PVC Pipe ,ae o�� e Install permanent marker �• a ,S at end of each lateral Holes Located On Bottom, Are Equally Spaced Q S PVC Force Main P PVC Manifold Pipe x Distri ution Pi e Last Hole Should Be I Next To End Cap End Cap . P 3 9 Ft. Distribution Pipe Layout S 3 Ft. X 'I Z Inches Y --)Z Inches Hole Diameter �f�l Inch Lateral Inches Manifold Inches Force Main " �- Inches # of holes /pipe _1 Invert Elevation of Laterals 99. -0 Ft. Lr Place lst hole 3 from center of manifold with succeeding holes at --) Z " intervals. Last hole to be next to the end cap. Combination Septic Tank and PLFMP CHAMBER CROSS SECTIOU ARID SPECIFICATIOWS ' PAGE S OF 6 VEIJT CAP WEATHER PROOF JUUCTIOIJ BOX 4'c.I. VENT PIPE APPROVED LOCKING �% 10' FROM DOOR, TMAIJIiOLE COVER wIlU .iitiDOW OR FRESH wARt.I1JJG L14<3EL. A R INTAKE c cwaDUir r tj `— — 18' MIL. IB'MINI.\ ---- - - - - -- Y 111 IIJLET µ PROVIDE I — - -- _j" AIRTIGHT SEAL I I I APPROVED JOI1 A I I I ( APPROVED JOILTS W /C.I. PIPE DR Tank construction i IiI W /C.I. PIPE oitPuc shall comply with ALARM ILHk 233.15 and 83.20 I i ow C I CLEY. �., 5 FT I PUMP — ' J � OFF D CONCRETE DLOCK RISER EXIT PERMITTED OMLJ IF TAIJK MAIJUFACTURCK HAS SUCH APPROVAL AP E( . SIG SEPTIC E SPEC.IFICATIOMS DOSE LUL COI.Ie�Z -�7E TANK MANUFACTURER: IJUMDER OF DOSES: 3' 9 PER OJRy TANK 51ZE: GALLOkIS DOSE VOLUME I ALARM MANUFACTURER: S•S. �l�C�"RQ S I 7 S II►ICI- UDIIJG 6ACKfLOW: -12 y GALLONS MODEL WUMBER: Q 1 IOW CAPACITIES: A= ZS INCHES OR L 402 GALLOys SWITCH TYPE: I'1(,rzC.tjl-Z'Lf g = Z IucHES ° oR 3 � G(►LLOA15 PUMP MANUFACTURER: Nl� � -S C: � � WCHES OR 1 ��' y CALLOUS MODEL NUM6ER: ICE p 1�lS. Z D- - -L_ ITCHES OR GALLOAIS `� SWITCH TYPE: MOTE: PUMP AMD ALARM ARE TO 5L Z MIIJIMUM DISCKARGE RATE 3�'7� GPM INSTALLED ON SEPARATE CIRCUITS VERTICAL DIFFEILEMCE DETWEEIJ PUMP OFF AUD•.DISTRIBUTIOU PIPE.. 18 ' Z S FEET + MIAJIMUM METWORK SUPPLY PRESSURE , ; , . , , . , , , , 2.50 FEET + 16S FEET OF FORCE MAIM X Z•Ly F Yo fEFRICTIO►J FACTOR__ L FEET TOTAL 09LIAMIC. HEAD = Zq.Z8 FEET Pump chamber DIAMETER — � ILITERWAL. DIMEIJ510kl� OF TAkIK: LELIGTH _ ;WIDTH ;LIQUID DEPTH L l - BOTTOM AREA - 231= GAL /INCH AS PER MANU = I6 •I3 GAL /INCH ME Series MYM 1/3 through 1 - 1/2 HP Effluent Pumps Performance Curve CAPACITY LITERS PER MINUTE 0 50 100 150 200 250 300 350 400 450 i 100 90 26 BO Ml-I�So 24 � 70 w ~ w M FG W 60 00 20 Z Z 0 C? - 50 M ��$ 16 w J O 40 MFS 1— 12 O I— 30 20 33 10 4 32: Ie 0 0 10 20 30 40 50 60 70 BO 90 100 110 120 130 0 CAPACITY GALLONS PER MINUTE e • 1101 Myers Parkway, Ashland, Ohio 44805 -1923 419/289 -1144 FAX 419/289 -6658 Telex 98 -7443 K3327 8/92 Printed in U.S.A. a-p mm S53o IK i6 S'oF �. , y , Z Auk yS cF qt F'1 Um. V L q 1 I 2 IAIW;j go FS 1 P rL41tcTWQ t I r )A-) FiZ.oST s 1,'V F' P tS'aF (44�� i LE! sT ?S= i� pr's' L e"T 1:3 6 -Z z q , Ali { L X N 26yp � C' WE a A : EiiS:JJRTH. � Labor a nd Department of Industry, S OIL AND SITE EVALUATION REPORT P 3 Labor and Human Relations OIL — Of „Division of'Safety & Buildings in accord with IL.HR 83.05, Wis. Adm. Code cou Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must include, but ,s. not limited to vertical and horizontal reference point (BA), direction and % of slope, scale or PAR dimensioned, north arrow, and location and distance to nearest road. APPLICANT INFORMATION PLEASE PRINT ALL INFORMATION REVI BY '' DATE PROPERTY OWNER: PROPERTY LOCATION �ttN 3G1'tt�N rr � �? ti (r'' 1/4 fit? 1/4,S $�, � ';`�r'r� E { PROPERTY OWNERS MAILING ADDRESS LOT BLOCK t I SUBD. NAME OR a 11 4 O y. ` - f'Pcj CH S'T'. N E - - ✓ � CITY STATE ZIP CODE PHONE NUMBER OCITY EIHILLAGE MOWN N h'1 L �1 M N SS36 WZ) - 7SS- 6 New Construction Use kj Residential / Number of bedrooms y [ ] Addition to existing !wilding L J Replacement [ I Public or commercial describe. Code derived dally flow 00 gpd Recommended design loading rate 0.3 bed, gpd/ft 0 trench, gpd/ft Absorption area required 50Z bed, ft S Ll O trench, ft Maximum design loading rate o • 5 bed,gVW trench, gpolft Recommended infiltration surface elevations) 9 , D ' ft (as referred to site plan benchmark) -TfBN_F 1y Additional design /site considerations Mtv W / 6'x %y • g k?b , M 0- , I '01P- Spr F O hs Pitt I L" i"3 Z 3 - ) Parent material SI. L` I4 oy ft - p LL. out �»�o►• -r t r� Rood plain elevation, if applicable f-j• A _ it j S = Suitable for system CONVENTIONAL MOUND IN- GROUND PRESSURE- AT GRADE SYSTEM IN FILL HOLDING TANK U= Unsuitable for system OS �U 0S OU EIS ®U [IS ®U OS ®U ❑S ®U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence R GPD /ft- in. Munsell Oil Sz. Cont Color Gr. Sz. Sh. g� zti sl I Z w ► c� ,., v a.s - o s o.b w ZZ � _L1 6o`IIZy[3 SO 2 CLv — o•S o.6: Ground 3. 1) -Z8 V6 \ tz316 - 5\ 0- Z s�� ti.,�i es o. L( a.S elev. 1 14 - 0 ft 4 - L? 3 L04 R_ 6 — Depth to limiting factor z O Remarks: Boring # L L-t L- V1t. v OLI g _ o. s o. L Z z -t6 1o`�cz�rf - sil Z_r y,. zk - a -s o.L Ground 3 16 -i6 Io`12 3L` - % Zs� tin� o ,S 0. Ct ft y 26 - LOYfL 3 �6 7-5L1R S le, S, LZVIA ►'�`�r' - - Depth to limiting j factor 1` Remarks: j CST Nave: Please Print Phone: . Arthur L. We erer 715- 425 -0165 egerer Soil Testing & Design Service -P.O. Box 74 River Fa11s,WI 54022 Signatse: Date: CST Number: X16 -"t M00576 PLOT PLAN Page 3 of 3 SCALE 1 "= y0 NV U�WSZ- ZS PiZor l I`?DU) �- Jh�1,l k � c SQ' ►c 4 P-� q4 - 2 C) � zs i loo rvoT Co�^1.wrrc.T � � ° d2 ��sYvr� -t3 ' PAZ-" p awc. tIV s "n►A, TI2 I t`, ` s tt9k 6 Z-1 �oti►�viZ LTLev. Ct6.0 ' ZU) ^-t of g vc) 97, b l r-j n L Q s h: c.l� RO "ScAtt„ 1" luoo' 4 i L ;3 S L� /� r - �4 � R6 - gS - L ---------- (715 ? 425 -nips M00576 CST Signature Date Signed Telephone No. CST # SAFETY I. N State of Wisconsin ri,4 Department of Industry, Labor and Human Relations May 29, 1996 2226 Rose Street La Crosse WI 54 3/_ WEGERER SOIL TESTING 421 N MAIN STREET PO BOX 74 RIVER FALLS WI 54022 RE: PLAN 596 -40454 FEE RECEIVED: 180.00 BERGMAN, JOHN NE,NE,20,28,19W TOWN OF TROY 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 ILHR 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 ILHR 82 or in chapters ILHR 50 -64 Wisconsin Administrative Code. - This approval does not include plans for the general plumbing systems or sewer piping leading to the septic /holding tank that may be required for this project. See section ILHR 82.20, Wis. Adm. Code, to determine if plan submittal and approval is required. 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. SBDA -7"7 (K. IWN) SAFETY & BUILDINGS DIVISION State of Wisconsin Department of Industry, Labor and Human Relations WEGERER SOIL TESTING Page 2 May 29, 1996 PLAN S96 -40454 Inquiries should be directed to me at the number listed below. Please refer to the plan number shown above. Sincerely, e erard M. Swim Plan Reviewer Section of Private Sewage (608) 785 -9348 SUDA -7997 (K. 10/84) ( ` i_ � ` 4�